A sphincterotome-based technique for selective transpapillary common bile duct cannulation

Background: Endoscopic retrograde cholangiopancreatography (ERCP) requires selective cannulation of the common bile duct and pancreatic duct. Selectiv e common bile and pancreatic duct cannulation with standard techniques can be achieved in most but not all cases even in experienced centers. To facil itate selective cannulation, sphincterotomes can be used, Methods: A prospective randomized study aimed at selective deep cannulation of the common bile and pancreatic ducts comparing different ERCP procedure s was performed. One hundred patients were randomly assigned to undergo can nulation with a standard catheter or with a guidewire sphincterotome (GS) w ithout guidewire, Results: The primary success rate of selective common bile duct cannulation was significantly higher in the GS group (84%) as compared with the standa rd catheter group (62%) (p = 0.023), In patients with primary standard cath eter failure, selective common bile duct cannulation was possible in 16 pat ients using a GS which increased the total success rate in the standard cat heter group to 94% (p < 0.001), In GS failures selective common bile duct c annulation was possible in two patients using a standard catheter and incre ased the total success rate from 84% to 88%. The frequency of postintervent ional pancreatitis did not differ significantly between the two groups. Conclusions: ERCP using a GS without guidewire has a significantly higher p rimary success rate for selective common bile duct cannulation then ERCP us ing a standard catheter,The use of a GS should be considered to optimize se lective cannulation of the common bile duct before resorting to precut tech niques.