{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,9]],"date-time":"2026-09-09T20:27:38Z","timestamp":1788985658848,"version":"build-2803163510"},"reference-count":39,"publisher":"Wiley","issue":"12","license":[{"start":{"date-parts":[[2025,9,9]],"date-time":"2025-09-09T00:00:00Z","timestamp":1757376000000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Digestive Endoscopy"],"published-print":{"date-parts":[[2025,12]]},"abstract":"ABSTRACT<\/jats:title>\n \n Background<\/jats:title>\n \n Difficult biliary cannulation is a key challenge in endoscopic retrograde cholangiopancreatography and a major risk factor for post\u2010\n ERCP<\/jats:styled-content>\n pancreatitis. When the pancreatic duct is unintentionally accessed, double guidewire (\n DGW<\/jats:styled-content>\n ) is the primary rescue strategy, while transpancreatic sphincterotomy (\n TPS<\/jats:styled-content>\n ) is an alternative. Previous evidence suggests that\n TPS<\/jats:styled-content>\n may achieve higher cannulation success and lower\n PEP<\/jats:styled-content>\n rates compared to\n DGW<\/jats:styled-content>\n , though direct comparative data remain limited. This review and meta\u2010analysis assess the clinical outcomes of\n TPS<\/jats:styled-content>\n and\n DGW<\/jats:styled-content>\n in the setting of difficult biliary cannulation.\n <\/jats:p>\n <\/jats:sec>\n \n Methods<\/jats:title>\n \n This review involved searching Medline, Embase, Lilacs, Central Cochrane, and Google Scholar. Outcomes assessed included\n PEP<\/jats:styled-content>\n , successful biliary cannulation, mean cannulation time, and other adverse events (bleeding, cholangitis, perforation).\n <\/jats:p>\n <\/jats:sec>\n \n Results<\/jats:title>\n \n A total of 463 patients from five randomized controlled trials were included. The\n DGW<\/jats:styled-content>\n group showed a higher risk of\n PEP<\/jats:styled-content>\n pancreatitis and other adverse events (\n p<\/jats:italic>\n \u2009=\u20090.009;\n RR<\/jats:styled-content>\n \u2009=\u20091.81 [1.16, 2.83];\n \n I<\/jats:italic>\n 2<\/jats:sup>\n <\/jats:styled-content>\n \u2009=\u200934%) and (\n p<\/jats:italic>\n \u2009=\u20090.03;\n RR<\/jats:styled-content>\n \u2009=\u20092.20 [1.10, 4.39];\n \n I<\/jats:italic>\n 2<\/jats:sup>\n <\/jats:styled-content>\n \u2009=\u20090%), respectively. A significant difference favoring\n TPS<\/jats:styled-content>\n was found for successful cannulation and mild pancreatitis (\n p<\/jats:italic>\n \u2009=\u20090.001;\n RR<\/jats:styled-content>\n \u2009=\u20091.79 [1.26, 2.54];\n \n I<\/jats:italic>\n 2<\/jats:sup>\n <\/jats:styled-content>\n \u2009=\u200940%) and (\n p<\/jats:italic>\n \u2009=\u20090.01;\n RR<\/jats:styled-content>\n \u2009=\u20092.26 [1.20, 4.28];\n \n I<\/jats:italic>\n 2<\/jats:sup>\n <\/jats:styled-content>\n \u2009=\u200935%), respectively. No significant difference was observed for mean cannulation time or moderate to severe\n PEP<\/jats:styled-content>\n (\n p<\/jats:italic>\n \u2009=\u20090.18;\n SMD<\/jats:styled-content>\n \u2009=\u2009\u22120.37 [\u22120.91, 0.17];\n \n I<\/jats:italic>\n 2<\/jats:sup>\n <\/jats:styled-content>\n \u2009=\u200979%) and (\n p<\/jats:italic>\n \u2009=\u20090.32;\n RR<\/jats:styled-content>\n \u2009=\u20091.50 [0.67, 3.36];\n \n I<\/jats:italic>\n 2<\/jats:sup>\n <\/jats:styled-content>\n \u2009=\u20090%), respectively. A restricted analysis excluding two studies affected by external factors inflating the pancreatitis rate did not reveal a significant difference (\n p<\/jats:italic>\n \u2009=\u20090.61;\n RR<\/jats:styled-content>\n \u2009=\u20091.16 [0.66, 2.04];\n \n I<\/jats:italic>\n 2<\/jats:sup>\n <\/jats:styled-content>\n \u2009=\u20090%).\n <\/jats:p>\n <\/jats:sec>\n \n Conclusion<\/jats:title>\n \n Prior studies comparing\n TPS<\/jats:styled-content>\n and\n DGW<\/jats:styled-content>\n yield different results. This may occur because there are technical variables that are difficult to control. Overall,\n TPS<\/jats:styled-content>\n demonstrated superior cannulation success, may have lower\n PEP<\/jats:styled-content>\n rates, and fewer other complications, although more homogeneous studies are needed to validate these findings.\n <\/jats:p>\n <\/jats:sec>","DOI":"10.1111\/den.70029","type":"journal-article","created":{"date-parts":[[2025,9,9]],"date-time":"2025-09-09T08:41:38Z","timestamp":1757407298000},"page":"1273-1285","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":6,"title":["Efficacy and Safety of Double Guidewire Versus Transpancreatic Sphincterotomy in Difficult Biliary Cannulation: A Systematic Review and Meta\u2010Analysis of\u00a0Randomized Clinical Trials"],"prefix":"10.1111","volume":"37","author":[{"ORCID":"https:\/\/orcid.org\/0009-0004-0352-9222","authenticated-orcid":false,"given":"Larissa Mercadante","family":"de Assis","sequence":"first","affiliation":[{"name":"Gastrointestinal Endoscopy Unit, Division of Gastroenterology Hospital das Cl\u00ednicas of the Faculty of Medicine of the University of S\u00e3o Paulo \u2013 HC\/FMUSP S\u00e3o Paulo Brazil"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4828-9320","authenticated-orcid":false,"given":"Mateus Pereira","family":"Funari","sequence":"additional","affiliation":[{"name":"Gastrointestinal Endoscopy Unit, Division of Gastroenterology Hospital das Cl\u00ednicas of the Faculty of Medicine of the University of S\u00e3o Paulo \u2013 HC\/FMUSP S\u00e3o Paulo Brazil"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7959-8313","authenticated-orcid":false,"given":"Luiza Bicudo","family":"de Oliveira","sequence":"additional","affiliation":[{"name":"Gastrointestinal Endoscopy Unit, Division of Gastroenterology Hospital das Cl\u00ednicas of the Faculty of Medicine of the University of S\u00e3o Paulo \u2013 HC\/FMUSP S\u00e3o Paulo 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