Introduction

Selective biliary cannulation is essential for successive endoscopic intervention.

Aim

To compare the efficacy and safety of the double-guidewire technique (DGT) versus cannulation over a pancreatic stent (CPS) following unintended pancreatic duct cannulation during endoscopic retrograde cholangiopancreatography (ERCP) in real-world clinical practice.

Material and methods

We conducted a prospective study including 103 patients who underwent ERCP between June and December 2024 at Kafrelsheikh University Hospital. Patients with difficult biliary cannulation and unintentional guidewire entry into the pancreatic duct during standard wire-guided cannulation were included. In these cases, either the DGT or CPS approach (with or without needle-knife sphincterotomy) was employed. Outcomes such as cannulation success time, number of attempts, and the need for precut sphincterotomy were recorded and analysed.

Results

The CPS group had a significantly higher requirement for precut sphincterotomy (88.6%) compared to the DGT group (33.3%) (p < 0.0001). A higher proportion of small papillae was observed in the CPS group (52.9%) versus the DGT group (47.1%). Time to successful biliary cannulation was significantly shorter in the DGT group (8.27 ±4.8 min) compared to the CPS group (11.84 ±3.2 min) (p = 0.0031).

Conclusions

The CPS technique required significantly more precut sphincterotomies than DGT. While the number of cannulation attempts was similar between techniques, DGT allowed for faster cannulation. CPS may reduce the risk of complications such as post-ERCP pancreatitis, but DGT appears more time-efficient. Selection of the appropriate technique should be based on individual anatomical and procedural factors.