Abstract

Background and aim: - Variable techniques could be used to raise the success rate and reduce complications of endoscopic retrograde cholangiopancreatography (ERCP). We aimed to evaluate the effect of indirect biliary cannulation techniques as double guide-wire technique (DGT), trans-pancreatic sphincterotomy (TPS) and\or temporary pancreatic stenting on ERCP procedure outcome. Patients and methods: - From 73 patients subjected to ERCP in our endoscopy unit, during the period between January 2016 to December 2017, 47 patients were managed with standard free direct cannulation maneuver (group-I), 21 patients managed with indirect maneuvers (DGT and\or TPS as group-II) and ERCP was failed in 5 cases; in 3 of them temporary pancreatic stent was placed but with no value. Results: - From 73 patients, standard free direct cannulation was done in 47 patients with success rate 64.4%, the remaining 26 patients managed with indirect maneuvers with successful cannulation of CBD in 21 cases with success rate 80.7% and total success rate of 94.4%. Procedure duration was longer in patients of indirect maneuvers than patients of standard free direct cannulation maneuver, with high significant difference (P value of 0.0036). The post-ERCP complications were noticed in 21 patients with complications rate of 28.8 %. Complications were significantly higher in patients of indirect maneuvers than patients of standard direct maneuver (47.6% vs. 23.4%). Post-ERCP pancreatitis recorded in 7 patients (9.6%) with significant higher rate in patients of indirect maneuvers than patients of direct maneuver (23.8% vs. 4.3%). Conclusion: - Indirect biliary cannulation (DGT and/or TPS) solved the problem of failed cannulation but had a higher rate of complications and took longer time.

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