Evidence map›Paper›PMID 40448903›Full record

Trial reportIndian journal of gastroenterology : official journal of the Indian Society of Gastroenterology2025

Pancreatic guidewire-assisted fistulotomy versus transpancreatic biliary sphincterotomy in difficult biliary cannulation with unintentional pancreatic duct cannulation: A randomized clinical trial.

Amir Sadeghi, Erfan Arabpour, Reyhaneh Rastegar, Ehsan Hosseinzadeh, Parya Mozafari Komesh Tape, Mohammad Reza Zali

Abstract readRandomized Controlled TrialComparative Study
PubMed Publisher
In one paragraph

Trial report in Indian journal of gastroenterology : official journal of the Indian Society of Gastroenterology, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 2 papers.

0numbers the graph read from it
0cells of the map it votes in
2citing papers in PubMed
–field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

2 citing papers in PubMed.

  1. Enhanced surgical management of complex anal fistulasWorld journal of gastrointestinal surgery · 2025
    Article
  2. Article
4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

6 authors.

Amir SadeghiGastroenterology and Liver Diseases Research Center, Research Institute for Gastroenterology and Liver Diseases, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
Erfan ArabpourGastroenterology and Liver Diseases Research Center, Research Institute for Gastroenterology and Liver Diseases, Shahid Beheshti University of Medical Sciences, Tehran, Iran. erfanarabpour1999@gmail.com.ORCID 0000-0003-0557-1278
Reyhaneh RastegarGastroenterology and Liver Diseases Research Center, Research Institute for Gastroenterology and Liver Diseases, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
Ehsan HosseinzadehGastroenterology and Liver Diseases Research Center, Research Institute for Gastroenterology and Liver Diseases, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
Parya Mozafari Komesh TapeGastroenterology and Liver Diseases Research Center, Research Institute for Gastroenterology and Liver Diseases, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
Mohammad Reza ZaliGastroenterology and Liver Diseases Research Center, Research Institute for Gastroenterology and Liver Diseases, Shahid Beheshti University of Medical Sciences, Tehran, Iran.

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

BACKGROUND AND

aimsDifficult biliary cannulation with unintentional pancreatic duct cannulation is a challenging issue, even for experienced endoscopists. This prospective, randomized, single-center trial aims to evaluate the safety and efficacy of two advanced rescue cannulation methods in this context: transpancreatic biliary sphincterotomy and pancreatic guidewire-assisted fistulotomy.

methodsPatients with intact papilla who were planned to undergo bile duct cannulation were screened and those who experienced difficult cannulation with at least two inadvertent pancreatic duct cannulations following unsuccessful double guidewire technique attempts were randomly assigned one of two rescue cannulation techniques: pancreatic guidewire-assisted fistulotomy and transpancreatic biliary sphincterotomy. The primary outcome was the cannulation success rate and the secondary outcome was the frequency of cannulation-related adverse events (trial registration number: IRCT20230314057717N1).

resultsTotal 730 patients were screened and 194 were recruited according to the study protocol (97 in each group). Successful biliary cannulation was achieved in 93.8% (n = 91) of the pancreatic guidewire-assisted fistulotomy group and 81.4% (n = 79) of the transpancreatic biliary sphincterotomy group (p-value = 0.01). Multivariate analysis revealed that the transpancreatic biliary sphincterotomy technique and a normal common bile duct diameter were independently associated with unsuccessful cannulation. No significant differences were observed regarding pancreatitis and other adverse events between the two groups (p = 0.31).

conclusionsIn difficult biliary cannulation accompanied by inadvertent pancreatic duct cannulation, following unsuccessful double guidewire technique, pancreatic guidewire-assisted fistulotomy is superior to transpancreatic biliary sphincterotomy for biliary cannulation, with similar rates of adverse events.

Indexed as

Bile DuctsCatheterizationCholangiopancreatography, Endoscopic RetrogradePancreatic DuctsSphincterotomy, EndoscopicAdultAgedFemaleHumansMaleMiddle AgedProspective StudiesTreatment OutcomeDifficult cannulationFistulotomyGuidewire-assistedSphincterotomy

Identifiers

PMID40448903

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Registered trials

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Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.