Needle-knife fistulotomy vs double-guidewire technique in patients with repetitive unintentional pancreatic cannulations

Table 1 Baseline characteristics (n = 134) n (%)

	Early NKF group	DGT group	P value
Age (yr), mean ± SD	65.5 ± 13.1	65.2 ± 14.0	0.889
Male sex	33 (49.3)	34 (50.7)	0.863
ERCP indications			0.165
Choledocholithiasis	30 (44.8)	38 (56.7)
Malignant stricture	32 (47.8)	20 (29.9)
Benign biliary stricture	4 (6.0)	7 (10.4)
Other	1 (1.5)	2 (3.0)
Periampullary diverticulum	9 (13.4)	25 (37.3)	0.001
Intradiverticular ampulla	0	2
Juxtadiverticular ampulla	9	23
Pancreas duct stent	4 (6.0)	5 (7.5)	1.000

NKF: Needle-knife fistulotomy; DGT: Double-guidewire technique.

Table 2 Clinical outcomes of the patients n (%)

	Early NKF group	DGT group	P value
Success rate of	53 (79.1)	30 (44.8)	< 0.001
assigned technique
Total success rate of
1st ERCP	53 (79.1)	55 (82.1)	0.662
2nd ERCP	61 (91.0)	62 (92.5)	0.753
Cannulation time after assignment, mean ± SD	4 min 17 s ± 115 s	5 min 12 s ± 137 s	0.013
Pancreatitis, total	3 (4.5)	10 (14.9)	0.041
Mild	1	5
Moderate	2	5
Hyperamylasemia	20 (29.9)	21 (31.3)	0.851
Perforation1	0	1	1.000

¹A perforation occurred during NKF in the DGT group and was treated conservatively. ERCP: Endoscopic retrograde cholangiopancreatography; NKF: Needle-knife fistulotomy; DGT: Double-guidewire technique.

Table 3 The success rate of biliary cannulation and the incidence of post-endoscopic retrograde cholangiopancreatography pancreatitis in double-guidewire technique in 5 randomized studies n (%)

Study	Study design	Patients screened	Patients randomized DGT	Timing of DGT	Success rate	Inadvertent success in DGT	PEP	Failure
Maeda et al[13], 2003	Single-center randomized study	107	27 (25)	Unsuccessful within 10 min	93%	NA	0%	NA
Herreros de Tejada et al[18], 2009	Multicenter randomized study	845	97 (11)	After 5 attempts	47%	18%	17%	10 more attempts
Angsuwatcharakon et al[16], 2012	Single-center randomized study	426	23 (5)	Unsuccessful within 10 min	73.9%	NA	21.7%	Another 10 min
Coté et al[27], 2012	Two-center randomized study	442	42 (10)	Unsuccessful within 6 min or 3 PD cannulations	54.8%	16.7%	2.4%	Another 6 min
Yoo et al[28], 2013	Single-center randomized study	1394	34 (2)	Unsuccessful within 10 min	79.4%	NA	38.2%	10 more attempts

PEP: Post-endoscopic retrograde cholangiopancreatography pancreatitis; DGT: Double-guidewire technique; PD: Pancreatic duct; NA: Not available.