USE OF THE DOUBLE-GUIDEWIRE TECHNIQUE IN COMPLEX BILIARY TRACT CANNULATION: THE ROLE OF PANCREATIC DUCT STENTING IN THE PREVENTION OF POST-ERCP PANCREATITIS
DOI:
https://doi.org/10.11603/2414-4533.2025.2.15398Keywords:
ERCP, post-ERCP pancreatitis, double-guidewire technique, stenting, biliary cannulationAbstract
The aim of the work: to evaluate the effectiveness of prophylactic pancreatic duct stenting (PPDS) in patients with high risk of post-ERCP pancreatitis (PEP) with complex bile duct cannulation using the DGT technique.
Materials and Methods. 510 cases of endoscopic retrograde cholangiopancreatography (ERCP) performed in Ternopil City Clinical Hospital No. 2 from 2015 to 2024 were reviewed. Of these, the results of 435 patients were included in the study, who were divided into three groups according to nosology. In cases of complex cannulation, the DGT technique was used, and if necessary, prophylactic stenting. PEP was determined according to clinical, laboratory and instrumental criteria. Statistical analysis was performed using the Pearson χ² test. Continuous variables (age, amylase level) were assessed using the Student test. One-way ANOVA was used to compare the three groups. Logistic regression was performed to analyze the risk factors for PEP with certain independent variables.
Results. The results of 435 ERCP cases that met the inclusion criteria were analyzed. The incidence of PEP in the group of patients with choledocholithiasis was 8.2 %. In the high-risk group, the incidence of PEP was 7.8 % when using the DGT plus PPDS technique, while it was 19.7 % when cannulated with SGT without stenting (p=0.03). In the group of patients with malignant stenoses, the risk of PEP was less frequent (1.6 %), in the group with strictures - not registered. The procedures were performed under general anesthesia with intubation and artificial pulmonary ventilation (MVL). As a prophylactic measure, all patients were administered a single rectal dose of Diclofenac (100 mg) immediately before surgery.
Conclusions. The DGT technique in combination with PPDS allows to effectively reduce the frequency of PEP in high-risk patients. Its implementation in clinical practice significantly improves the results of endoscopic interventions.
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