If you don't remember your password, you can reset it by entering your email address and clicking the Reset Password button. You will then receive an email that contains a secure link for resetting your password
If the address matches a valid account an email will be sent to __email__ with instructions for resetting your password
Pancreatic guidewire-assisted biliary cannulation, also known as the double-guidewire (DGW) technique, after failure of deep cannulation of the common bile duct (CBD) was first described in 1998 by Dumonceau et al.
The aim of the DGW technique is to obstruct the pancreatic orifice and facilitate deep biliary cannulation.
We report the case of a 40-year-old man with chronic alcoholic pancreatitis presenting with a dilation of the Wirsung duct complicated by a 4-cm fluid pseudocyst in the body of the pancreas in communication with the pancreatic duct (Fig. 1A, B, Fig. 2). Deep cannulation of the main pancreatic duct failed despite several attempts with different angles of cannulation. Cannulation of the CBD was eventually achieved. Therefore, we decided to leave the guidewire in the CBD (Fig. 3). Afterward, because of obstruction of the biliary orifice, a more precise cannulation of the pancreatic orifice was possible, obtaining selective Wirsung duct cannulation (Fig. 4). Pancreatography showed major duct dilation coupled with a stricture and spillage of contrast inside the pseudocyst (Fig. 5). Pancreatic sphincterotomy was performed (Fig. 6), followed by hydrostatic 6-mm dilation (Fig. 7). A stent with multiple side holes (10F, 14 cm) was then deployed with the distal end inside the cavity and the proximal end transpapillary to achieve internal drainage and calibration of the pancreatic duct (Figure 8, Figure 9, Video 1, available online at www.VideoGIE.org). Recovery was uneventful, and stent replacement was scheduled in 3 months.
The DGW technique is a useful tool for the management of difficult cannulation. Guidewire cannulation of the CBD to achieve pancreatic cannulation in cases of difficult pancreatic access is a feasible and effective technique.
All authors disclosed no financial relationships relevant to this publication.
Biliary guidewire-assisted pancreatic duct cannulation, endoscopic pancreatic sphincterotomy, hydrostatic dilation, and plastic stenting of the main pancreatic duct to achieve internal drainage of pseudocyst and calibration of the pancreatic duct.