Transpancreatic Sphincterotomy Is a Safe and Effective Pancreatic Guidewire-Assisted Cannulation Method: Real-World Data Analysis of the Hungarian ERCP Registry

Pécsi, Dániel; Farkas, Nelli; Gódi, Szilárd; Hegyi, Péter; Szentesi, Andrea; Altorjay, István; Bakucz, Tamás; Orbán-Szilágyi, Ákos; Szepes, Zoltán; Czakó, László; Patai, Árpád; Gyökeres, Tibor; Fejes, Roland; Dubravcsik, Zsolt; Vincze, Áron

doi:10.3390/jcm14197118

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Transpancreatic Sphincterotomy Is a Safe and Effective Pancreatic Guidewire-Assisted Cannulation Method: Real-World Data Analysis of the Hungarian ERCP Registry

by

Dániel Pécsi

^1,2

,

Nelli Farkas

^1,3

,

Szilárd Gódi

²,

Péter Hegyi

^1,4,

Andrea Szentesi

¹,

István Altorjay

⁵,

Tamás Bakucz

⁶,

Ákos Orbán-Szilágyi

⁶,

Zoltán Szepes

⁷,

László Czakó

⁷

,

Árpád Patai

⁸,

Tibor Gyökeres

⁶

,

Roland Fejes

⁹,

Zsolt Dubravcsik

¹⁰

and

Áron Vincze

^2,*

¹

Institute for Translational Medicine, Medical School, University of Pécs, 7624 Pécs, Hungary

²

Division of Interventional Gastroenterology, First Department of Medicine, Medical School, University of Pécs, 7624 Pécs, Hungary

³

Institute for Bioanalysis, Medical School, University of Pécs, 7624 Pécs, Hungary

⁴

Centre of Translational Medicine, Semmelweis University, 1085 Budapest, Hungary

⁵

Gastroenterology Clinic, University of Debrecen, 4032 Debrecen, Hungary

⁶

Department of Gastroenterology, Central Hospital of Northern Pest—Military Hospital, 1134 Budapest, Hungary

⁷

First Department of Medicine, University of Szeged, 6720 Szeged, Hungary

⁸

First Department of Gastroenterology and Medicine, Markusovszky University Teaching Hospital, 9700 Szombathely, Hungary

⁹

First Department of Medicine, Szent György University Teaching Hospital of County Fejér, 8000 Székesfehérvár, Hungary

¹⁰

Bács-Kiskun County University Teaching Hospital, 6000 Kecskemét, Hungary

^*

Author to whom correspondence should be addressed.

J. Clin. Med. 2025, 14(19), 7118; https://doi.org/10.3390/jcm14197118 (registering DOI)

Submission received: 15 July 2025 / Revised: 22 September 2025 / Accepted: 4 October 2025 / Published: 9 October 2025

(This article belongs to the Section Gastroenterology & Hepatopancreatobiliary Medicine)

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Abstract

Background/Objectives: Difficult biliary cannulation during endoscopic retrograde cholangiopancreatography (ERCP) poses significant challenges and increases the risk of adverse events. Pancreatic guidewire (PGW)-assisted techniques offer potential solutions, but real-world comparative data are limited. Methods: This cohort study of prospectively collected data analyzed 234 ERCP cases from the Hungarian ERCP Registry, focusing on three PGW-assisted methods: transpancreatic sphincterotomy (TPS), double-guidewire technique (DGW), and prophylactic pancreatic stent-assisted cannulation (PPS-C). Results: TPS demonstrated the highest primary cannulation success rate (83.1%), significantly outperforming DGW (67.7%) and PPS-C (67.6%) (p < 0.001). With salvage methods, cannulation success was high across all groups. Post-ERCP pancreatitis rates were low (5.0% TPS, 5.6% DGW, 3.9% PPS-C), but prophylactic measures (pancreatic stents, indomethacin) were underutilized. Conclusions: Our findings suggest that TPS is a safe and effective alternative for difficult biliary cannulation in ERCP. Routine considerations of post-ERCP pancreatitis prophylaxis (prophylactic pancreatic stents and non-steroidal suppositories) are recommended in all PGW-assisted cannulations to minimize complications.

Keywords: endoscopic retrograde cholangiopancreatography; advanced cannulation; biliary cannulation; adverse events; transpancreatic sphincterotomy; Post-ERCP pancreatitis

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MDPI and ACS Style

Pécsi, D.; Farkas, N.; Gódi, S.; Hegyi, P.; Szentesi, A.; Altorjay, I.; Bakucz, T.; Orbán-Szilágyi, Á.; Szepes, Z.; Czakó, L.; et al. Transpancreatic Sphincterotomy Is a Safe and Effective Pancreatic Guidewire-Assisted Cannulation Method: Real-World Data Analysis of the Hungarian ERCP Registry. J. Clin. Med. 2025, 14, 7118. https://doi.org/10.3390/jcm14197118

AMA Style

Pécsi D, Farkas N, Gódi S, Hegyi P, Szentesi A, Altorjay I, Bakucz T, Orbán-Szilágyi Á, Szepes Z, Czakó L, et al. Transpancreatic Sphincterotomy Is a Safe and Effective Pancreatic Guidewire-Assisted Cannulation Method: Real-World Data Analysis of the Hungarian ERCP Registry. Journal of Clinical Medicine. 2025; 14(19):7118. https://doi.org/10.3390/jcm14197118

Chicago/Turabian Style

Pécsi, Dániel, Nelli Farkas, Szilárd Gódi, Péter Hegyi, Andrea Szentesi, István Altorjay, Tamás Bakucz, Ákos Orbán-Szilágyi, Zoltán Szepes, László Czakó, and et al. 2025. "Transpancreatic Sphincterotomy Is a Safe and Effective Pancreatic Guidewire-Assisted Cannulation Method: Real-World Data Analysis of the Hungarian ERCP Registry" Journal of Clinical Medicine 14, no. 19: 7118. https://doi.org/10.3390/jcm14197118

APA Style

Pécsi, D., Farkas, N., Gódi, S., Hegyi, P., Szentesi, A., Altorjay, I., Bakucz, T., Orbán-Szilágyi, Á., Szepes, Z., Czakó, L., Patai, Á., Gyökeres, T., Fejes, R., Dubravcsik, Z., & Vincze, Á. (2025). Transpancreatic Sphincterotomy Is a Safe and Effective Pancreatic Guidewire-Assisted Cannulation Method: Real-World Data Analysis of the Hungarian ERCP Registry. Journal of Clinical Medicine, 14(19), 7118. https://doi.org/10.3390/jcm14197118

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Transpancreatic Sphincterotomy Is a Safe and Effective Pancreatic Guidewire-Assisted Cannulation Method: Real-World Data Analysis of the Hungarian ERCP Registry

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