Skip Navigation LinksHome > March 2010 - Volume 44 - Issue 3 > Dye-free Wire-guided Cannulation of the Biliary Tree During...
Journal of Clinical Gastroenterology:
doi: 10.1097/MCG.0b013e3181aacbd1
ONLINE ARTICLES: Original Articles

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*

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Abstract

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.

© 2010 Lippincott Williams & Wilkins, Inc.

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