Fast access to the Common Bile Duct during Endoscopic Retrograde Cholangio-Pancreatography, our experience with a double wire technique.

J Andres Astudillo, MD, Jean Carlos Jimenez, MD, Jose M Martinez, MD. University of Miami, Department of Laparoendoscopic Surgery, Miami, FL..

Repeated cannulation of the pancreatic duct (PD) while attempting to cannulate the common bile duct (CBD) is often encountered during Endoscopic retrograde cholangiopancreatograpy (ERCP). This often leads to unsuccessful cannulation or post procedure complications. The use of a double wire technique, in which, once wire guided access is obtained in the PD, a second wire is used to gain access into the CBD, has shown to aid in the successful cannulation of the CBD. We propose a series to evaluate success and time to successful cannulation if the double wire technique is employed as soon as PD cannulation is achieved.

A total of 39 patients required an ERCP over a three month period. Of these, 7 patients required the use of the double wire technique as cannulation of the PD was the first duct accessed. Data was collected on these 7 consecutive patients undergoing ERCP in which the double wire technique was used. Time from wire cannulation of pancreatic duct until successful cannulation of CBD was recorded. Patients were followed for post ERCP complications

Time from cannulation of PD until successful cannulation of CBD was as follow: The average time to cannulation post PD wire access was 120 seconds. All attempts of using the double wire were successful in gaining access into the CBD. There were no reported complications on this series.

The use of double wire technique to gain successful cannulation of CBD after gaining access to PD has been reported. No clear consensus has been established as to how early in the intervention should one proceed with double wire technique prior to continuing reattempts at CBD canulation. This small series demonstrate quick cannulation is achieved when proceeding with double wire cannulation post first access to PD. The early conversion to this technique should minimize ampullary trauma and post intervention complications.

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