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Dye-free Wire-guided Cannulation of the Biliary Tree During ERCP is Associated With High Success and Low Complication Rates: Outcomes in a Single Operator Experience of 822 Cases

Adler, Douglas G. MD, FACG, FASGE*; Verma, Dharmendra MD; Hilden, Kristen MS*; Chadha, Romil MBBS; Thomas, Kristen*

Journal of Clinical Gastroenterology: March 2010 - Volume 44 - Issue 3 - pp e57-e62
doi: 10.1097/MCG.0b013e3181aacbd1
ONLINE ARTICLES: Original Articles

Background: Deep biliary cannulation (DBC) is a prerequisite to most endoscopic retrograde cholangiopancreatographies (ERCPs). Numerous techniques have been described to maximize success and minimize ERCP-related complications, most notably post-ERCP pancreatitis. Dye-free cannulation by using guidewires with hydrophilic tips has been proposed as a technique with a high rate of success and a low rate of complications. We report the outcomes 822 consecutive ERCP procedures by using dye-free guidewire cannulation techniques.

Objective: To evaluate the success rate for DBC and rates of complications by using dye-free guidewire cannulation techniques.

Design: Retrospective. Consecutive ERCP procedures with intent to achieve DBC exclusively by using dye-free guidewire technique were included. Complication data on post-ERCP pancreatitis, bleeding, perforation, and cholangitis were extracted.

Setting: University.

Patients: Patients undergoing biliary ERCP.

Interventions: ERCP.

Main Outcome Measurements: Success, complication rates.

Results: Eight hundred and twenty-two ERCPs were performed on 744 patients. Five hundred and fifty-nine (68%) procedures were performed on inpatients, 263 (32%) on outpatients. DBC was successful in 801 of 822 (97%) ERCPs. In 795 of 801 (99%) ERCPs with successful DBC procedures, DBC was achieved in a dye-free fashion. Eleven patients (1.3%) developed post-ERCP pancreatitis—all cases were mild. Guidewire perforations occurred 11 times (1.3%), none required surgery. Ten of 11 patients with known or suspected (91%) guidewire perforation achieved successful DBC on repeat ERCP by the same endoscopist by using dye-free techniques.

Limitations: Retrospective.

Conclusions: In this large retrospective case series, a high success rate of DBC was achieved by using dye-free guidewire techniques. This technique has associated lower rates of complications in comparison to those reported earlier.

*University of Utah, School of Medicine, Salt Lake City

Utah University of Texas, Houston Health Science Center, Houston, TX

The authors have no relevant financial disclosures.

There was no funding required for this study.

Reprints: Douglas G. Adler, MD, FACG, FASGE, Director of Therapeutic Endoscopy, Gastroenterology and Hepatology, Huntsman Cancer Center, University of Utah, Salt Lake City, Utah (e-mail: douglas.adler@hsc.utah.edu).

Received for publication January 18, 2009

accepted April 16, 2009

© 2010 Lippincott Williams & Wilkins, Inc.