Comparison of the early double-wire technique with the repeat single-wire technique for successful bile duct cannulation: a systematic review and meta-analysis

BACKGROUND/AIMS: Inadvertent pancreatic duct cannulation during endoscopic retrograde cholangiopancreatography (ERCP) presents a challenge in selective bile duct cannulation. Potential strategies include early double-guidewire (EDG) and repeated single-guidewire (RSG) techniques, though comparative effectiveness remains unclear. To evaluate the efficacy and safety of EDG versus RSG in patients with unintentional pancreatic duct cannulation during ERCP for biliary interventions. METHODS: We conducted a systematic review and meta-analysis of randomized controlled trials and cohort studies comparing EDG and RSG from Cochrane Central Register of Controlled Trials, Embase, and Ovid Medline until February 25, 2025. The primary outcome was successful bile duct cannulation. Secondary outcomes included rate of post-ERCP pancreatitis (PEP). RESULTS: Three studies comprising 464 patients (228 EDG, 236 RSG) were included. The pooled risk ratio for successful biliary cannulation favored EDG (1.38; 95% confidence interval [CI], 0.96-1.99; p=0.08). Rates of PEP were similar between groups (risk ratio, 1.12; 95% CI, 0.69-1.82; p=0.64). Subgroup analyses suggested greater benefit of EDG when performed by expert endoscopists (risk ratio, 1.42; 95% CI, 1.05-1.91, p=0.02). CONCLUSIONS: EDG may improve cannulation success in selected populations, particularly under expert operators, without increasing PEP risk. Considerable heterogeneity underscores the need for further large-scale studies to clarify its role.