Journal of Surgery Concepts & Practice >

2023 , Vol. 28 >Issue 06: 540 - 550

DOI: https://doi.org/10.16139/j.1007-9610.2023.06.010

Original article

Efficacy of different methods for difficult biliary cannulation in ERCP: systematic review and network meta-analysis

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  • Department of General Surgery, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200025, China

Received date: 2022-10-31

  Online published: 2024-03-04

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Abstract

Objective To assess the comparative efficacy of different methods for difficult biliary cannulation in endoscopic retrograde cholangio-pancreatography (ERCP) through a network meta-analysis. Methods Randomized controlled trials (RCTs) that compared the efficacy of different adjunctive methods (early or late needle-knife technique, pancreatic guidewire-assisted technique, pancreatic stent-assisted technique, transpancreatic sphincterotomy, persistent standard cannulation technique) for difficult biliary cannulation with each other were identified. The success rate of biliary cannulation and the incidence of post-ERCP pancreatitis (PEP) were the outcomes of interest. Pairwise and network meta-analysis and ranking according to surface under the cumulative ranking curve(SUCRA) for all methods were performed. Results Eighteen RCTs were identified according to selection criteria, and 2 033 patients were enrolled. The use of transpancreatic sphincterotomy over persistent standard cannulation technique (RR=1.34, 95% CI: 1.02-1.77) and over pancreatic guidewire-assisted technique（RR=1.26, 95% CI: 1.00-1.60）significantly increased the success rate of biliary cannulation. Based on SUCRA ranking, transpancreatic sphincterotomy followed by early needle-knife techniques were ranked highest in terms of increasing the success rate of biliary cannulation. Only early needle-knife technique significantly decreased PEP rate when compared with persistent standard cannulation technique (RR=0.53, 95％CI: 0.30-0.94), whereas both early needle-knife techniques and transpancreatic sphincterotomy led to lower PEP rates as compared with pancreatic guidewire-assisted technique (RR=0.41， 95％CI: 0.17-0.99; RR=0.49， 95％CI: 0.25-0.96; respectively). Based on SUCRA ranking, early needle-knife technique followed by transpancreatic sphincterotomy were ranked highest for decreasing the PEP rate of biliary cannulation. Conclusions Transpancreatic sphincterotomy increases the success rate of difficult biliary cannulation in ERCP; early needle-knife technique and transpancreatic sphincterotomy are superior to other interventions in decreasing PEP rates and should be considered as a choice of difficult biliary cannulation.

Key words： Endoscopic retrograde cholangio-pancreatography; Difficult biliary cannulation; Network meta-analysis

Cite this article

QI Yang, YAO Wenfei, LI Qianyi, YAO Wei, KONG Lei, XU Ruiyun, WU Yuquan, LI Nengping . Efficacy of different methods for difficult biliary cannulation in ERCP: systematic review and network meta-analysis[J]. Journal of Surgery Concepts & Practice, 2023 , 28(06) : 540 -550 . DOI: 10.16139/j.1007-9610.2023.06.010

References

[1] TSE F, YUAN Y, MOAYYEDI P, et al. Guidewire-assisted cannulation of the common bile duct for the prevention of post-endoscopic retrograde cholangiopancreatography (ERCP) pancreatitis[J]. Cochrane Database Syst Rev, 2012, 12(12):CD009662.
[2] WILLIAMS E J, TAYLOR S, FAIRCLOUGH P, et al. Are we meeting the standards set for endoscopy?Results of a large-scale prospective survey of endoscopic retrograde cholangiopancreatograph practice[J]. Gut, 2007, 56(6):821-829.
[3] TESTONI P A, MARIANI A, AABAKKEN L, et al. Papillary cannulation and sphincterotomy techniques at ERCP:European Society of Gastrointestinal Endoscopy (ESGE) clinical guideline[J]. Endoscopy, 2016, 48(7):657-683.
[4] HALTTUNEN J, MEISNER S, AABAKKEN L, et al. Difficult cannulation as defined by a prospective study of the scandinavian association for digestive endoscopy (SADE) in 907 ERCPs[J]. Scand J Gastroenterol, 2014, 49(6):752-758.
[5] LIAO W C, ANGSUWATCHARAKON P, ISAYAMA H, et al. International consensus recommendations for difficult biliary access[J]. Gastrointest Endosc, 2017, 85(2):295-304.
[6] FREEMAN M L, DISARIO J A, NELSON D B, et al. Risk factors for post-ERCP pancreatitis: a prospective, multicenter study[J]. Gastrointest Endosc, 2001, 54(4):425-434.
[7] WANG P, LI Z S, LIU F, et al. Risk factors for ERCP-related complications: a prospective multicenter study[J]. Am J Gastroenterol, 2009, 104(1):31-40.
[8] PéCSI D, FARKAS N, HEGYI P, et al. Transpancreatic sphincterotomy has a higher cannulation success rate than needle-knife precut papillotomy da meta-analysis[J]. Endoscopy, 2017, 49(9):874-887.
[9] PUHAN M A, SCHüNEMANN H J, MURAD M H, et al. A GRADE Working Group approach for rating the qua-lity of treatment effect estimates from network meta-analysis[J]. BMJ, 2014, 349:g5630.
[10] HIGGINS J P, ALTMAN D G, G?TZSCHE PC, et al. The cochrane collaboration’s tool for assessing risk of bias in randomised trials[J]. BMJ, 2011, 343:d5928.
[11] MAEDA S, HAYASHI H, HOSOKAWA O, et al. Prospective randomized pilot trial of selective biliary cannulation using pancreatic guide-wire placement[J]. Endoscopy, 2003, 35(9):721-724.
[12] CATALANO M F, LINDER J D, GEENEN J E. Endoscopic transpancreatic papillary septotomy for inaccessible obstructed bile ducts:comparison with standard pre-cut papillotomy[J]. Gastrointest Endosc, 2004, 60(4):557-561.
[13] TANG S J, HABER G B, KORTAN P, et al. Precut papillotomy versus persistence in difficult biliary cannulation:a prospective randomized trial[J]. Endoscopy, 2005, 37(1):58-65.
[14] ZHOU P H, YAO L Q, XU M D, et al. Application of needle-knife in difficult biliary cannulation for endoscopic retrograde cholangiopancreatography[J]. Hepatobiliary Pancreat Dis Int, 2006, 5(4):590-594.
[15] MANES G, DI GIORGIO P, REPICI A, et al. An analysis of the factors associated with the development of complications in patients undergoing precut sphincterotomy: a prospective, controlled, randomized, multicenter study[J]. Am J Gastroenterol, 2009, 104(10):2412-2417.
[16] CENNAMO V, FUCCIO L, REPICI A, et al. Timing of precut procedure does not influence success rate and complications of ERCP procedure: a prospective rando-mized comparative study[J]. Gastrointest Endosc, 2009, 69(3):473-479.
[17] HERREROS DE TEJADA A, CALLEJA J L, DíAZ G, et al. Double-guidewire technique for difficult bile duct cannulation: a multicenter randomized,controlled trial[J]. Gastrointest Endosc, 2009, 70(4):700-709.
[18] COTé G A, MULLADY D K, JONNALAGADDA S S, et al. Use of a pancreatic duct stent or guidewire facilitates bile duct access with low rates of precut sphinctero-tomy: a randomized clinical trial[J]. Dig Dis Sci, 2012, 57(12):3271-3278.
[19] ANGSUWATCHARAKON P, RERKNIMITR R, RIDTITID W, et al. Success rate and cannulation time between precut sphincterotomy and double-guidewire technique in truly difficult biliary cannulation[J]. J Gastroenterol Hepatol, 2012, 27(2):356-361.
[20] SWAN M P, ALEXANDER S, MOSS A, et al. Needle knife sphincterotomy does not increase the risk of pancrea-titis in patients with difficult biliary cannulation[J]. Clin Gastroenterol Hepatol, 2013, 11(4):430-436.
[21] YOO Y W, CHA S W, LEE W C, et al. Double guidewire technique vs. transpancreatic precut sphincterotomy in difficult biliary cannulation[J]. World J Gastroenterol, 2013, 19(1):108-114.
[22] ZANG J, ZHANG C, GAO J. Guidewire-assisted transpancreatic sphincterotomy for difficult biliary cannulation: a prospective randomized controlled trial[J]. Surg Laparosc Endosc Percutan Tech, 2014, 24(5):429-433.
[23] MARIANI A, DI LEO M, GIARDULLO N, et al. Early precut sphincterotomy for difficult biliary access to reduce post-ERCP pancreatitis: a randomized trial[J]. Endoscopy, 2016, 48(6):530-535.
[24] ZAGALSKY D, GUIDI M A, CURVALE C, et al. Early precut is as efficient as pancreatic stent in preventing post-ERCP pancreatitis in high-risk subjectsda rando-mized study[J]. Rev Esp Enferm Dig, 2016, 108(9):558-562.
[25] SUGIYAMA H, TSUYUGUCHI T, SAKAI Y, et al. Transpancreatic precut papillotomy versus double-guidewire technique in difficult biliary cannulation:prospective randomized study[J]. Endoscopy, 2018, 50(1):33-39.
[26] EMINLER A T, PARLAK E, KOKSAL A S, et al. Wire-guided cannulation over a pancreatic stent method increases the need for needle-knife precutting in patients with difficult biliary cannulations[J]. Gastrointest Endosc, 2019, 89(2):301-308.
[27] TABAK F, WANG F, JI G Z, et al. Propensity score-matched analysis for comparing transpancreatic sphincterotomy and needle-knife precut in difficult biliary cannulation[J]. Sci Rep, 2021, 11(1):6059.
[28] KYL?NP?? L, KOSKENSALO V, SAARELA A, et al. Transpancreatic biliary sphincterotomy versus double guidewire in difficult biliary cannulation:a randomized controlled trial[J]. Endoscopy, 2021, 53(10):1011-1019.
[29] PéCSI D, FARKAS N, HEGYI P, et al. Transpancreatic sphincterotomy is effective and safe in expert hands on the short term[J]. Dig Dis Sci, 2019, 64(9):2429-2444.
[30] CHEN J, WAN J H, WU D Y, et al. Assessing quality of precut sphincterotomy in patients with difficult biliary access: an updated metaanalysis of randomized controlled trials[J]. J Clin Gastroenterol, 2018, 52(7):573-578.
[31] JANG S I, KIM D U, CHO J H, et al. Primary needle-knife fistulotomy versus conventional cannulation method in a high-risk cohort of post-endoscopic retrograde cho-langiopancreatography pancreatitis[J]. Am J Gastroenterol, 2020, 115(4):616-624.
[32] 李谦益, 姚文飞, 祁洋, 等. 胰管支架表面括约肌预切开在ERCP困难胆管插管中的应用效果[J]. 肝胆胰外科杂志, 2022, 34(3):129-133.
  LI Q Y, YAO W F, QI Y, et al. Efficacy of precut over a pancreatic duct stent for difficult biliary cannulation in ERCP[J]. J Hepatopancreatobiliary Surg, 2022, 34(3):129-133.
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