Outcomes of Different Guidewire-Assisted Techniques for Recurrent Malignant Biliary Obstruction After Uncovered Metallic Stent Placement.

OBJECTIVES: We aimed to compare the clinical outcomes of the bent guidewire insertion (BGI) technique and the conventional straight guidewire insertion (SGI) technique for managing recurrent malignant biliary obstruction (RMBO) after initial uncovered metallic stent (UMS) placement. METHODS: Ninety patients who underwent endoscopic intervention for RMBO after UMS placement were retrospectively included. Clinical outcomes and endoscopic retrograde cholangiopancreatography (ERCP)-related factors were compared between the SGI and BGI groups. Univariate and multivariate logistic regression analyses were performed to identify the independent risk factors associated with difficult cannulation. RESULTS: There were 43 and 47 patients who underwent the SGI and BGI techniques, respectively, for intervention of RMBO. The SGI group had significantly higher rates of difficult cannulation (48.8% vs. 19.1%, p = 0.006) and guidewire insertion technique transformation (44.2% vs. 4.3%, p < 0.001). Additionally, procedure time (49.7 min ± 23.4 min vs. 34.7 min ± 20.5 min, p = 0.002) and cannulation time (5.0 min vs. 4.0 min, p = 0.005) were longer in the SGI group. Technical and clinical success rates, procedure-related complications, and length of hospitalization were comparable between the two groups. Multivariate analysis revealed that SGI (odds ratio [OR] 4.682, 95% confidence interval [CI] 1.643-13.340, p = 0.004) and hilar biliary tract lesions (OR 3.673, 95% CI 1.236-10.915, p = 0.019) were identified as independent factors for difficult biliary cannulation. CONCLUSION: BGI technique may be superior to SGI approach for re-intervention in patients with RMBO after initial UMS placement.