การศึกษาแบบสุ่มเปรียบเทียบระยะเวลาในการใส่สายเข้าท่อน้ำดี ระหว่างการตัดหูรูดท่อน้ำดีก่อนและการใช้ลวดนำสองเส้น ในผู้ป่วยที่ใส่สายเข้าท่อน้ำดีได้ยาก / พรเทพ อังศุวัชรากร = Comparison of cannulation time between precut sphincterotomy and double guidewire in difficult-to-access biliary cannulation;prospective, randomized study
Background: Precut sphincterotomy (PS) is usually indicated in difficult biliary cannulation. PS requires a steep learning curve and contains significant risk of complications. Double guidewire (DG) has been reported to be useful after failed standard biliary cannulation. Objective: To compare cannulation time, success rate, post-ERCP serum amylase level, and complication rate between DG and PS techniques in difficult biliary cannulation. Methods: Patients who failed biliary cannulation within 10 minutes were randomized into DG or PS groups. Patients with altered surgical anatomy, obstructed pancreatic duct, and history of pancreatitis were excluded. Results: Forty patients were randomized, 22 in DG and 18 in PS groups. The mean cannulation time are 147.5 and 346.1 seconds in DG and PS group, respectively (p < 0.001). Success rates are 72.7% in DG and 83.3% in PS group (p = 0.424). Pancreatitis occurs in 18.2% in DG and 5.6% in PS group (p = 0.355). The mean level of serum amylase at 24 hours after ERCP is 1173.2 and 239.2 mg/dL in DG and PS, respectively (p < 0.001). Conclusion: Double wire cannulation provides significant shorter duration of biliary cannulation and similar success rate as compared with precut technique. Post-ERCP serum amylase level in the double guide-wire group was significantly higher but the rate of clinically significant pancreatitis was not statistically difference.