A Randomized Controlled Trial Comparing Different Interventional Techniques for Difficult Common Bile Duct Cannulation in Endoscopic Retrograde Cholangiopancreatography
Sallam, A., Alhaddad, O., Elsabaawy, M., Mahmoud, E., Khamis, A., Edrees, A. (2025). A Randomized Controlled Trial Comparing Different Interventional Techniques for Difficult Common Bile Duct Cannulation in Endoscopic Retrograde Cholangiopancreatography. EKB Journal Management System, 2025(2), 101-109. doi: 10.21608/aimj.2025.446424
Ahmed Elsaid Sallam; Omkolsoum Elsayed Alhaddad; Maha Mohamed Elsabaawy; Eman Abdelsameea Mahmoud; Ahmed Kamal Khamis; Ahmed Mohamed Edrees. "A Randomized Controlled Trial Comparing Different Interventional Techniques for Difficult Common Bile Duct Cannulation in Endoscopic Retrograde Cholangiopancreatography". EKB Journal Management System, 2025, 2, 2025, 101-109. doi: 10.21608/aimj.2025.446424
Sallam, A., Alhaddad, O., Elsabaawy, M., Mahmoud, E., Khamis, A., Edrees, A. (2025). 'A Randomized Controlled Trial Comparing Different Interventional Techniques for Difficult Common Bile Duct Cannulation in Endoscopic Retrograde Cholangiopancreatography', EKB Journal Management System, 2025(2), pp. 101-109. doi: 10.21608/aimj.2025.446424
Sallam, A., Alhaddad, O., Elsabaawy, M., Mahmoud, E., Khamis, A., Edrees, A. A Randomized Controlled Trial Comparing Different Interventional Techniques for Difficult Common Bile Duct Cannulation in Endoscopic Retrograde Cholangiopancreatography. EKB Journal Management System, 2025; 2025(2): 101-109. doi: 10.21608/aimj.2025.446424

A Randomized Controlled Trial Comparing Different Interventional Techniques for Difficult Common Bile Duct Cannulation in Endoscopic Retrograde Cholangiopancreatography

Al-Azhar International Medical Journal
Volume 2025, Issue 2, February 2025, Page 101-109  XML PDF (434.28 K)
Document Type: Original Article
DOI: 10.21608/aimj.2025.446424
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Authors
Ahmed Elsaid Sallam* 1; Omkolsoum Elsayed Alhaddad2; Maha Mohamed Elsabaawy2; Eman Abdelsameea Mahmoud2; Ahmed Kamal Khamis2; Ahmed Mohamed Edrees2
1Hepatology and Gastroenterology Mahalla Hepatology Teaching Hospital, General Organization of Teaching Hospitals, Mahalla, AL Gharbia, Egypt
2Hepatology and Gastroenterology, National Liver Institute, Menoufia University, Menoufia, Egypt
Abstract
Background: The gold standard for diagnosing and treating pancreatic-biliary disorders is endoscopic retrograde cholangiopancreatography (ERCP).
Aim: To evaluate the effectiveness of precut and fistulotomy procedures, trans-pancreatic sphincterotomy (TPS), and the double guidewire technique (DGT) in patients with challenging biliary cannulation (DBC).
Patients and Procedures: 150 ERCP candidates with DBC participated in this prospective randomised research. Three groups of patients were randomly assigned: Group I (DGT), Group II (TPS), and Group III (fistulotomy method or needle knife precut).
Results: Out of the 812 patients who were initially enrolled, 622 were able to successfully undergo selective cannulation. The remaining 150 patients were randomized. The success rates of initial and final cannulation were comparable among the three groups (P=0.882), periampullary diverticulum type (P=0.354), successful cannulation both initial and final endoscopic sphincterotomy (P=0.957), first and second cannulation time, hospital stay (P=0.328), cholangitis (P=0.485), bleeding (P=0.107), and post-ERCP (PEP) problems (P=0.151). The only significant difference was less contrast injection in the fistulotomy and precut group (P < 0.005).
Conclusions: With similar success rates, trans-pancreatic sphincterotomy (TPS), precut and fistulotomy, or the double guidewire approach can all be effectively used to handle difficult ERCP cannulation
Keywords
Interventional Techniques; Bile Duct; Difficult Cannulation; Endoscopic Retrograde Cholangiopancreatography
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