Pancreatic guidewire-assisted fistulotomy proves more effective

In a trial involving 194 patients facing difficult biliary cannulation, the pancreatic guidewire-assisted fistulotomy method achieved a significantly higher success rate of 93.8%, compared to 81.4% for the transpancreatic biliary sphincterotomy technique (p=0.01). Both techniques exhibited similar rates of adverse events, suggesting that fistulotomy is the preferred choice after failed cannulation attempts. The transpancreatic method was particularly associated with unsuccessful outcomes due to specific anatomical conditions.