Larissa Mercadante de Assis, Mateus Pereira Funari, Luiza Bicudo de Oliveira, Benjamin Ian Richter, Miriam Chinzon, Vitor Hernandes Lopes, Matheus Oliveira Veras, Marcos Eduardo Lera Dos Santos, Gustavo Oliveira Luz, Wanderley Marques Bernardo, Eduardo Guimarães Hourneaux de Moura
{"title":"双导丝与经胰括约肌切开术在困难胆道插管中的疗效和安全性：随机临床试验的系统回顾和荟萃分析。","authors":"Larissa Mercadante de Assis, Mateus Pereira Funari, Luiza Bicudo de Oliveira, Benjamin Ian Richter, Miriam Chinzon, Vitor Hernandes Lopes, Matheus Oliveira Veras, Marcos Eduardo Lera Dos Santos, Gustavo Oliveira Luz, Wanderley Marques Bernardo, Eduardo Guimarães Hourneaux de Moura","doi":"10.1111/den.70029","DOIUrl":null,"url":null,"abstract":"<p><strong>Background: </strong>Difficult biliary cannulation is a key challenge in endoscopic retrograde cholangiopancreatography and a major risk factor for post-ERCP pancreatitis. When the pancreatic duct is unintentionally accessed, double guidewire (DGW) is the primary rescue strategy, while transpancreatic sphincterotomy (TPS) is an alternative. Previous evidence suggests that TPS may achieve higher cannulation success and lower PEP rates compared to DGW, though direct comparative data remain limited. This review and meta-analysis assess the clinical outcomes of TPS and DGW in the setting of difficult biliary cannulation.</p><p><strong>Methods: </strong>This review involved searching Medline, Embase, Lilacs, Central Cochrane, and Google Scholar. Outcomes assessed included PEP, successful biliary cannulation, mean cannulation time, and other adverse events (bleeding, cholangitis, perforation).</p><p><strong>Results: </strong>A total of 463 patients from five randomized controlled trials were included. The DGW group showed a higher risk of PEP pancreatitis and other adverse events (p = 0.009; RR = 1.81 [1.16, 2.83]; I<sup>2</sup> = 34%) and (p = 0.03; RR = 2.20 [1.10, 4.39]; I<sup>2</sup> = 0%), respectively. A significant difference favoring TPS was found for successful cannulation and mild pancreatitis (p = 0.001; RR = 1.79 [1.26, 2.54]; I<sup>2</sup> = 40%) and (p = 0.01; RR = 2.26 [1.20, 4.28]; I<sup>2</sup> = 35%), respectively. No significant difference was observed for mean cannulation time or moderate to severe PEP (p = 0.18; SMD = -0.37 [-0.91, 0.17]; I<sup>2</sup> = 79%) and (p = 0.32; RR = 1.50 [0.67, 3.36]; I<sup>2</sup> = 0%), respectively. A restricted analysis excluding two studies affected by external factors inflating the pancreatitis rate did not reveal a significant difference (p = 0.61; RR = 1.16 [0.66, 2.04]; I<sup>2</sup> = 0%).</p><p><strong>Conclusion: </strong>Prior studies comparing TPS and DGW yield different results. This may occur because there are technical variables that are difficult to control. Overall, TPS demonstrated superior cannulation success, may have lower PEP rates, and fewer other complications, although more homogeneous studies are needed to validate these findings.</p>","PeriodicalId":72813,"journal":{"name":"Digestive endoscopy : official journal of the Japan Gastroenterological Endoscopy Society","volume":" ","pages":""},"PeriodicalIF":4.7000,"publicationDate":"2025-09-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":"{\"title\":\"Efficacy and Safety of Double Guidewire Versus Transpancreatic Sphincterotomy in Difficult Biliary Cannulation: A Systematic Review and Meta-Analysis of Randomized Clinical Trials.\",\"authors\":\"Larissa Mercadante de Assis, Mateus Pereira Funari, Luiza Bicudo de Oliveira, Benjamin Ian Richter, Miriam Chinzon, Vitor Hernandes Lopes, Matheus Oliveira Veras, Marcos Eduardo Lera Dos Santos, Gustavo Oliveira Luz, Wanderley Marques Bernardo, Eduardo Guimarães Hourneaux de Moura\",\"doi\":\"10.1111/den.70029\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<p><strong>Background: </strong>Difficult biliary cannulation is a key challenge in endoscopic retrograde cholangiopancreatography and a major risk factor for post-ERCP pancreatitis. When the pancreatic duct is unintentionally accessed, double guidewire (DGW) is the primary rescue strategy, while transpancreatic sphincterotomy (TPS) is an alternative. Previous evidence suggests that TPS may achieve higher cannulation success and lower PEP rates compared to DGW, though direct comparative data remain limited. This review and meta-analysis assess the clinical outcomes of TPS and DGW in the setting of difficult biliary cannulation.</p><p><strong>Methods: </strong>This review involved searching Medline, Embase, Lilacs, Central Cochrane, and Google Scholar. Outcomes assessed included PEP, successful biliary cannulation, mean cannulation time, and other adverse events (bleeding, cholangitis, perforation).</p><p><strong>Results: </strong>A total of 463 patients from five randomized controlled trials were included. The DGW group showed a higher risk of PEP pancreatitis and other adverse events (p = 0.009; RR = 1.81 [1.16, 2.83]; I<sup>2</sup> = 34%) and (p = 0.03; RR = 2.20 [1.10, 4.39]; I<sup>2</sup> = 0%), respectively. A significant difference favoring TPS was found for successful cannulation and mild pancreatitis (p = 0.001; RR = 1.79 [1.26, 2.54]; I<sup>2</sup> = 40%) and (p = 0.01; RR = 2.26 [1.20, 4.28]; I<sup>2</sup> = 35%), respectively. No significant difference was observed for mean cannulation time or moderate to severe PEP (p = 0.18; SMD = -0.37 [-0.91, 0.17]; I<sup>2</sup> = 79%) and (p = 0.32; RR = 1.50 [0.67, 3.36]; I<sup>2</sup> = 0%), respectively. A restricted analysis excluding two studies affected by external factors inflating the pancreatitis rate did not reveal a significant difference (p = 0.61; RR = 1.16 [0.66, 2.04]; I<sup>2</sup> = 0%).</p><p><strong>Conclusion: </strong>Prior studies comparing TPS and DGW yield different results. This may occur because there are technical variables that are difficult to control. Overall, TPS demonstrated superior cannulation success, may have lower PEP rates, and fewer other complications, although more homogeneous studies are needed to validate these findings.</p>\",\"PeriodicalId\":72813,\"journal\":{\"name\":\"Digestive endoscopy : official journal of the Japan Gastroenterological Endoscopy Society\",\"volume\":\" \",\"pages\":\"\"},\"PeriodicalIF\":4.7000,\"publicationDate\":\"2025-09-09\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"Digestive endoscopy : official journal of the Japan Gastroenterological Endoscopy Society\",\"FirstCategoryId\":\"1085\",\"ListUrlMain\":\"https://doi.org/10.1111/den.70029\",\"RegionNum\":0,\"RegionCategory\":null,\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"\",\"PubModel\":\"\",\"JCR\":\"\",\"JCRName\":\"\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"Digestive endoscopy : official journal of the Japan Gastroenterological Endoscopy Society","FirstCategoryId":"1085","ListUrlMain":"https://doi.org/10.1111/den.70029","RegionNum":0,"RegionCategory":null,"ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"","JCRName":"","Score":null,"Total":0}
Efficacy and Safety of Double Guidewire Versus Transpancreatic Sphincterotomy in Difficult Biliary Cannulation: A Systematic Review and Meta-Analysis of Randomized Clinical Trials.
Background: Difficult biliary cannulation is a key challenge in endoscopic retrograde cholangiopancreatography and a major risk factor for post-ERCP pancreatitis. When the pancreatic duct is unintentionally accessed, double guidewire (DGW) is the primary rescue strategy, while transpancreatic sphincterotomy (TPS) is an alternative. Previous evidence suggests that TPS may achieve higher cannulation success and lower PEP rates compared to DGW, though direct comparative data remain limited. This review and meta-analysis assess the clinical outcomes of TPS and DGW in the setting of difficult biliary cannulation.
Methods: This review involved searching Medline, Embase, Lilacs, Central Cochrane, and Google Scholar. Outcomes assessed included PEP, successful biliary cannulation, mean cannulation time, and other adverse events (bleeding, cholangitis, perforation).
Results: A total of 463 patients from five randomized controlled trials were included. The DGW group showed a higher risk of PEP pancreatitis and other adverse events (p = 0.009; RR = 1.81 [1.16, 2.83]; I2 = 34%) and (p = 0.03; RR = 2.20 [1.10, 4.39]; I2 = 0%), respectively. A significant difference favoring TPS was found for successful cannulation and mild pancreatitis (p = 0.001; RR = 1.79 [1.26, 2.54]; I2 = 40%) and (p = 0.01; RR = 2.26 [1.20, 4.28]; I2 = 35%), respectively. No significant difference was observed for mean cannulation time or moderate to severe PEP (p = 0.18; SMD = -0.37 [-0.91, 0.17]; I2 = 79%) and (p = 0.32; RR = 1.50 [0.67, 3.36]; I2 = 0%), respectively. A restricted analysis excluding two studies affected by external factors inflating the pancreatitis rate did not reveal a significant difference (p = 0.61; RR = 1.16 [0.66, 2.04]; I2 = 0%).
Conclusion: Prior studies comparing TPS and DGW yield different results. This may occur because there are technical variables that are difficult to control. Overall, TPS demonstrated superior cannulation success, may have lower PEP rates, and fewer other complications, although more homogeneous studies are needed to validate these findings.
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