|
|
Back to 2017 Posters
DOUBLE GUIDEWIRE ENDOSCOPIC TECHNIQUE, A MAJOR EVOLUTION IN ENDOSCOPIC RETROGRADE CHOLANGIOPANCREATOGRAPHY: RESULTS OF A RETROSPECTIVE STUDY WITH HISTORICAL CONTROLS COMPARING TWO THERAPEUTIC SEQUENTIAL STRATEGIES
Etienne Desilets*1, Arthur Laquière2, Arthur Belle2, Paul Castellani2, Philippe Grandval3, René Laugier3, Laurence Lecompte2, Christian Boustière2
1Gastroenterology, Université de Sherbrooke, Longueuil, QC, Canada; 2Gastroenterology, Hôpital St-Joseph, Marseille, France; 3Gastroenterology, Hôpital La Timone, Marseille, France
Background and aim: Endoscopic access to the common bile duct (CBD) remains difficult in 10% of cases, requiring alternative techniques. CBD access was difficult after either five unsuccessful attempts, five unintentional insertions into the pancreatic duct or >10-min-long unsuccessful attempts. This retrospective study with historical controls aimed to evaluate the benefit of the double guidewire (DGW) technique after failure of standard CBD cannulation.
Methods: From January 2012 to December 2014, all patients requiring therapeutic endoscopic retrograde cholangiopancre- atography (ERCP) with difficult access to CBD were included in a Studied group. This group was compared to a historical ERCP control group from January 2009 to December 2011. In the Studied group, a sequential strategy including DGW technique was done when the guidewire was unintentionally passed into the pancreatic duct. In the control group, only pre-cut technique was used.
Results: Among the 538 patients with naive papilla eligible for ERCP, 73 had difficult CBD access. Successful CBD access rate was higher in the Studied group: 91% (50/55) versus 67% (12/18) P = 0.0215. Complication rates were similar in both groups: 28% versus 20%, P = 0.5207. Lenght of stay (LOS) was shorter in the Studied group (9.2 +- 8.5 vs 14.4 +- 7.4 days, P = 0.0028). Post-ERCP cholangitis were lower in the Studied group: 2% (1/55) versus 22% (4/ 18), P = 0.0118.
Conclusion: After standard cannulation failure, DGW technique increased successful CBD access rate and decreased LOS without increasing complications.
Comparison of patient characteristics for each group
| Parameter | Total cohort (n = 73) | Before 2012
(n = 18) ‘2009-2011 Control’ group | Since 2012 (n = 55) ‘2012-2014 Studied’ group | P-value* (<2012 vs ≥2012) | | Age, mean ± SD (years) | 71.7 ± 14.0 | 78.4 ± 9.2 | 69.5 ± 14.6 | 0.0109 | | Men, n (%) | 44 (60%) | 10 (56%) | 34 (62%) | 0.7823 | | Indications | | | | | | Stone, n (%) | 32 (44%) | 8 (44%) | 24 (44%) | 0.8370 | | Pancreatic cancer, n (%) | 20 (27%) | 6 (33%) | 14 (25%) | | | Hilar neoplasia, n (%) | 12 (16%) | 3 (17%) | 9 (16%) | | | Bile leakage, n (%) | 3 (4%) | 0 | 3 (5%) | | | Other, n (%) | 6 (8%) | 1 (6%) | 5 (9%) | |
*Significant P-value: <0.05 (chi-squared comparison test or Fisher’s exact test for categorical data; Wilcoxon non-parametric test for continuous data). Comparison of success rate, length of hospital stay and complications in the two groups | Parameter | Total cohort (n = 73) | Before 2012 (n = 18) ‘2009-2011 Control’ group | Since 2012 (n = 55) ‘2012-2014 Studied’ group | Odds ratio (CI 95) | P-value* (<2012 vs ≥2012) | | Success, n (%) | 62 (85%) | 12 (67%) | 50 (91%) | 5.00 (1.30-19.17) | 0.0215 | | Failure, n (%) | 11 (15%) | 6 (33%) | 5 (9%) | | | Length of hospital
stay, mean ± SD (days) | 10.5 ± 8.5 | 14.4 ± 7.4 | 9.2 ± 8.5 | | 0.0028 | | Complication rate, N (%) | 16 (22%) | 5 (28%) | 11 (20%) | 0.65 (0.19-2.21) | 0.5207 | | No complication, N (%) | 57 (78%) | 13 (72%) | 44 (80%) | | | | Complications details | | | | | | | Perforation, N (%) | 0 | - | - | | - | | Cholangitis, N (%) | 5 (7%) | 4 (22%) | 1 (2%) | | 0.0118 | | Cholecystitis, N (%) | 0 | - | - | | - | | Hemorrhage, N (%) | 5 (7%) | 0 | 5 (9%) | | 0.3241 | | Other, N (%) | 2 (3%) | 2 (11%) | 0 | | 0.0063 | | Pancreatitis, N (%) | 8 (11%) | 2 (11%) | 6 (11%) | | 1.0000 | | Death, N (%) | 0 | - | - | | - |
*Significant P-value: <0.05 (chi-squared comparison test or Fisher’s exact test for categorical data; Wilcoxon non-parametric test for continuous data).
Back to 2017 Posters
|
