{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,26]],"date-time":"2026-08-26T20:28:15Z","timestamp":1787776095405,"version":"build-2784847793"},"reference-count":31,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"1","content-domain":{"domain":["lww.com","ovid.com"],"crossmark-restriction":true},"short-container-title":[],"published-print":{"date-parts":[[2015,1]]},"abstract":"<jats:sec>\n                    <jats:title>Background\/Aims:<\/jats:title>\n                    <jats:p>The double-guidewire technique (DGT) and transpancreatic precut sphincterotomy (TPS) are introduced as alternative biliary cannulation techniques for difficult biliary cannulation. This study aimed to evaluate the sequential use of DGT and TPS compared with a needle-knife precut papillotomy (NK).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Patients and Methods:<\/jats:title>\n                    <jats:p>Six hundred and thirty-five consecutive patients with na\u03bfve papilla and who underwent endoscopic retrograde cholangiopancreatography (ERCP) for biliary cannulation from March 2010 to April 2014 in a single institute were analyzed. When standard techniques were unsuccessful, DGT or NK was performed. TPS was sequentially performed if DGT failed.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results:<\/jats:title>\n                    <jats:p>\n                      DGT and NK were attempted in 65 and 58 patients, respectively. A sequential DGT-TPS was performed in 38 patients after a failed DGT. Biliary cannulations were successful in 42%, 74%, and 66% of the DGT, sequential DGT-TPS, and NK patients, respectively (\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      = 0.002). The cannulation rate was higher in the DGT \u00b1 TPS patients (85%) than in the NK patients (\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      = 0.014). Post-ERCP pancreatitis (PEP) developed in 26% of the successful DGT patients, 37% of the sequential DGT-TPS patients, and 10% of the NK patients (\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      = 0.008). Of the sequential DGT-TPS patients, the incidence of PEP was significantly reduced in patients with a pancreatic duct (PD) stent compared with patients without a PD stent (24% vs. 62%,\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      = 0.023).\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions:<\/jats:title>\n                    <jats:p>Sequential DGT-TPS is a useful alternative method compared with NK for patients in whom biliary cannulation is difficult. In the sequential DGT-TPS patients, the incidence of PEP was significantly reduced with the use of a PD stent.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.4103\/1319-3767.151212","type":"journal-article","created":{"date-parts":[[2015,2,11]],"date-time":"2015-02-11T02:40:59Z","timestamp":1423622459000},"page":"18-24","update-policy":"https:\/\/doi.org\/10.1097\/lww.0000000000001000","source":"Crossref","is-referenced-by-count":14,"title":["Sequential Double-Guidewire Technique and Transpancreatic Precut Sphincterotomy for Difficult Biliary Cannulation"],"prefix":"10.4103","volume":"21","author":[{"given":"Chang W.","family":"Kim","sequence":"first","affiliation":[{"name":"Department of Internal Medicine, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jae H.","family":"Chang","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine, College of Medicine, The 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