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Rivista di Chirurgia
Indexed/Abstracted in: EMBASE, PubMed/MEDLINE, Science Citation Index Expanded (SciSearch), Scopus
Impact Factor 0,877
Minerva Chirurgica 2017 Apr 19
Copyright © 2017 EDIZIONI MINERVA MEDICA
Single versus two-operator endoscopic biliary cannulation technique: a multicenter matched-case analysis and a literature review
Roberto DI MITRI 1, Rinaldo PELLICANO 2, Leonardo H. EUSEBI 3, 4, Filippo MOCCIARO 1, Luigi M. MONTALBANO 5, Angela ALIBRANDI 6, Giuseppe IABICHINO 7, Maria A. PALAMARA 7, Marco GIUNTA 5, Cristina LINEA 5, Monica ARENA 7, Giulia M. PECORARO 1, Enrico OPOCHER 8, 9, Matteo BARABINO 8, 9, Carmelo LUIGIANO 7 ✉
1 Unit of Gastroenterology and Digestive Endoscopy, ARNAS Civico Hospital, Palermo, Italy; 2 Department of Gastro-Hepatology, Molinette Hospital, Turin, Italy; 3 HPB Endoscopy, Royal Free Hospital, London, UK; 4 Department of Medical and Surgical Sciences (DIMEC), University of Bologna, Bologna, Italy; 5 Unit of Gastroenterology, Villa Sofia, V. Cervello Hospital, Palermo, Italy; 6 Department of Statistics, University of Messina, Messina, Italy; 7 Unit of Digestive Endoscopy, San Paolo Hospital, Milan, Italy; 8 Department of Surgery, Unit of Hepatobilyopancreatic and Digestive Surgery, San Paolo Hospital, University of Milan, Milan, Italy; 9 Digestive Surgery, San Paolo Hospital, University of Milan, Milan, Italy
BACKGROUND: The aim of this study was to compare the outcomes of physician-controlled, using both long and short endoscopic-retrograde-cholangiopancreatography wire systems, and assistant-controlled guide-wire biliary cannulation techniques, and to perform a literature review on this topic.
METHODS: The endoscopic databases of three Endoscopic Centers were reviewed to identify all consecutive patients with an intact papilla who, between July 2013 and December 2014, underwent an endoscopic-retrograde-cholangiopancreatography. A total of 240 patients (80 for each group) were matched 1:1, by gender, age and indications for procedure and were included in the analysis. All articles of physician-controlled vs. assistant-controlled guide-wire biliary cannulation techniques, were extracted up to December 2016, and included in the review.
RESULTS: There were no statistically significant differences in primary and final (using rescue technique) cannulation rate between the three groups. The mean primary cannulation time and overall cannulation time were shorter in the two groups of physician-controlled guide-wire compared to the assistant-controlled guide-wire group, but the difference was not statistically significant. The total procedure time did not differ significantly between the 3 groups, but the physician-controlled guide-wire using short wire system was associated with a trend toward a shorter time compared to the other two techniques. There were no statistically significant differences in complication rates between the three groups. Three pertinent articles were included in the review. The mean procedure success and complication rates were 92% and 7%, respectively.
CONCLUSIONS: The literature review and our results shows that all these techniques have equally efficacy and safety for guide-wire cannulation.
KEY WORDS: Biliary cannulation - Physician-controlled guide-wire cannulation - Assistant-controlled guide-wire cannulation - Post-procedure complications - Post-ERCP pancreatitis