Use of a pancreatic duct stent or guidewire facilitates bile duct access with low rates of precut sphincterotomy

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dc.contributor.author Azar, Riad R.
dc.contributor.author Coté, Gregory A.
dc.contributor.author Mullady, Daniel K.
dc.contributor.author Jonnalagadda, Sreenivasa S.
dc.contributor.author Keswani, Rajesh N.
dc.contributor.author Wani, Sachin B.
dc.contributor.author Hovis, Christine E.
dc.contributor.author Ammar, Tarek
dc.date.accessioned 2016-09-19T11:30:50Z
dc.date.available 2016-09-19T11:30:50Z
dc.date.copyright 2012 en_US
dc.identifier.issn 0163-2116 en_US
dc.identifier.uri http://hdl.handle.net/10725/4311
dc.description.abstract Background and Study Aims Among cases of difficult biliary cannulation, alternatives include use of a pancreatic duct stent (PDS) or guidewire (PDW) to facilitate access. We compared the effectiveness of a PDS versus a PDW to facilitate common bile duct (CBD) cannulation. Patients and Methods We conducted a randomized, crossover trial at two endoscopy referral centers, limited to patients undergoing ERCP without a history of biliary sphincterotomy. After meeting predefined criteria for difficult cannulation, patients were randomized to using a PDS or PDW to facilitate CBD cannulation. Outcomes included cannulation rate within 6 min, overall cannulation rate, frequency of precut, and complication rates. Results Among 442 eligible patients, 87 (19.7 %) met criteria for difficult cannulation. Forty two were randomized to PDW, 54 to PDS (including 9 PDW patients crossed over to PDS). The rate of CBD cannulation within 6 min was similar in the PDW (38.1 %) and PDS (51.9 %) groups (p = 0.18). In a secondary analysis limited to patients who successfully underwent PDW or PDS deployment, the rate was also comparable (PDW 59.3 %, PDS 65.1 %; p = 0.62). The overall frequency of CBD cannulation was 66.7 % in PDW and 90.7 % in PDS patients. Precut was required in 9.5 % of PDW and 25.9 % of PDS patients. Complication rates were similar, with 4 (4.6 %) patients having post-ERCP pancreatitis and 1 (1.1 %) having post-ERCP pain without confirmation of pancreatitis. Conclusions Use of a PDS or PDW facilitates CBD cannulation while maintaining a low complication rate and reducing the need for precut sphincterotomy in the majority of cases. en_US
dc.language.iso en en_US
dc.title Use of a pancreatic duct stent or guidewire facilitates bile duct access with low rates of precut sphincterotomy en_US
dc.type Article en_US
dc.description.version Published en_US
dc.title.subtitle a randomized clinical trial en_US
dc.author.school SOM en_US
dc.author.idnumber 200902767 en_US
dc.author.department N/A en_US
dc.description.embargo N/A en_US
dc.relation.journal Digestive Diseases and Sciences en_US
dc.journal.volume 57 en_US
dc.journal.issue 12 en_US
dc.article.pages 3271–3278 en_US
dc.keywords Cannulation en_US
dc.keywords ERCP en_US
dc.keywords Stent en_US
dc.keywords Bile duct en_US
dc.keywords Endoscopy en_US
dc.identifier.doi http://dx.doi.org/10.1007/s10620-012-2269-2 en_US
dc.identifier.ctation Coté, G. A., Mullady, D. K., Jonnalagadda, S. S., Keswani, R. N., Wani, S. B., Hovis, C. E., ... & Azar, R. R. (2012). Use of a pancreatic duct stent or guidewire facilitates bile duct access with low rates of precut sphincterotomy: a randomized clinical trial. Digestive diseases and sciences, 57(12), 3271-3278. en_US
dc.author.email riad.azar@lau.edu.lb en_US
dc.identifier.tou http://libraries.lau.edu.lb/research/laur/terms-of-use/articles.php en_US
dc.identifier.url http://link.springer.com/article/10.1007/s10620-012-2269-2 en_US

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