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Comparison between loop-tip guidewire-assisted and conventional endoscopic cannulation in high risk patients.

Masci E, Mangiavillano B, Luigiano C, Bizzotto A, Limido E, Cantù P, Manes G, Viaggi P, Spinzi G, Radaelli F, Mariani A, Virgilio C, Alibrandi A, Testoni PA - Endosc Int Open (2015)

Bottom Line: The rates of PEP were 5 % in the GWC group and 12 % in the CC group (P = 0.027).The post-interventional complication rates did not differ between the two groups.GWC with the new wire guide is associated with a lower rate of PEP in comparison with the CC technique.

View Article: PubMed Central - PubMed

Affiliation: Gastrointestinal Endoscopy Unit, San Paolo University Hospital, University of Milan, Milan, Italy.

ABSTRACT

Background: The guidewire biliary cannulation (GWC) technique may increase the cannulation rate and decrease the risk for post-endoscopic retrograde cholangiopancreatography (ERCP) pancreatitis. The aim of our multicenter prospective randomized controlled trial was to determine if the use of an atraumatic loop-tip guidewire reduces the rate of post-ERCP pancreatitis (PEP) compared with the standard contrast-assisted cannulation (CC) technique.

Methods: From June 2012 to December 2013, a total of 320 patients who had a naïve papilla and were referred for ERCP were randomly assigned to the GWC group (n = 160) or the CC group (n = 160). GWC or CC was randomly used. In cases of failed cannulation in both arms after crossover, biliary access was attempted with alternative techniques (e. g., dual-wire technique, pancreatic duct stenting, precut).

Results: The biliary cannulation rates were 81 % in the GWC group and 73 % in the CC group (P = n. s.). Following crossover, cannulation was successful in 8 % and 11 % of patients in the GWC and CC groups, respectively. With use of an alternative technique, the cannulation rates were 98 % in the GWC group and 96 % in the CC group, respectively. The rates of PEP were 5 % in the GWC group and 12 % in the CC group (P = 0.027). The post-interventional complication rates did not differ between the two groups.

Conclusion: GWC with the new wire guide is associated with a lower rate of PEP in comparison with the CC technique. Clinical trial reference number: NCT01771419.

No MeSH data available.


Related in: MedlinePlus

 Loop-tip wire.
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FI261-1:  Loop-tip wire.

Mentions: Guidewire cannulation group: In the GWC group, the sphincterotome was preloaded with a 0.035-in loop-tip guidewire (Fig. 1). The sphincterotome was oriented from the 11- to the 12-o’clock position on the papilla and bent to align it correctly with the bile duct axis. After a minimal insertion (2 – 3 mm) of the sphincterotome across the ampulla, the guidewire was carefully advanced through the CBD under fluoroscopy until it was seen entering the bile duct (Fig. 2). In cases of PD cannulation, the guidewire was withdrawn, and attempts were made to redirect it toward the CBD. Such attempts were continued for no longer than 5 minutes or up to five unintentional cannulations of the PD. If biliary cannulation was achieved through guidewire insertion, contrast medium was injected, whereas in a case of failure, the patient was crossed over to the CC technique for a time limit of 5 minutes or for a maximum of three repeated, unintentional contrast injections or cannulations of the main PD.


Comparison between loop-tip guidewire-assisted and conventional endoscopic cannulation in high risk patients.

Masci E, Mangiavillano B, Luigiano C, Bizzotto A, Limido E, Cantù P, Manes G, Viaggi P, Spinzi G, Radaelli F, Mariani A, Virgilio C, Alibrandi A, Testoni PA - Endosc Int Open (2015)

 Loop-tip wire.
© Copyright Policy
Related In: Results  -  Collection

Show All Figures
getmorefigures.php?uid=PMC4612233&req=5

FI261-1:  Loop-tip wire.
Mentions: Guidewire cannulation group: In the GWC group, the sphincterotome was preloaded with a 0.035-in loop-tip guidewire (Fig. 1). The sphincterotome was oriented from the 11- to the 12-o’clock position on the papilla and bent to align it correctly with the bile duct axis. After a minimal insertion (2 – 3 mm) of the sphincterotome across the ampulla, the guidewire was carefully advanced through the CBD under fluoroscopy until it was seen entering the bile duct (Fig. 2). In cases of PD cannulation, the guidewire was withdrawn, and attempts were made to redirect it toward the CBD. Such attempts were continued for no longer than 5 minutes or up to five unintentional cannulations of the PD. If biliary cannulation was achieved through guidewire insertion, contrast medium was injected, whereas in a case of failure, the patient was crossed over to the CC technique for a time limit of 5 minutes or for a maximum of three repeated, unintentional contrast injections or cannulations of the main PD.

Bottom Line: The rates of PEP were 5 % in the GWC group and 12 % in the CC group (P = 0.027).The post-interventional complication rates did not differ between the two groups.GWC with the new wire guide is associated with a lower rate of PEP in comparison with the CC technique.

View Article: PubMed Central - PubMed

Affiliation: Gastrointestinal Endoscopy Unit, San Paolo University Hospital, University of Milan, Milan, Italy.

ABSTRACT

Background: The guidewire biliary cannulation (GWC) technique may increase the cannulation rate and decrease the risk for post-endoscopic retrograde cholangiopancreatography (ERCP) pancreatitis. The aim of our multicenter prospective randomized controlled trial was to determine if the use of an atraumatic loop-tip guidewire reduces the rate of post-ERCP pancreatitis (PEP) compared with the standard contrast-assisted cannulation (CC) technique.

Methods: From June 2012 to December 2013, a total of 320 patients who had a naïve papilla and were referred for ERCP were randomly assigned to the GWC group (n = 160) or the CC group (n = 160). GWC or CC was randomly used. In cases of failed cannulation in both arms after crossover, biliary access was attempted with alternative techniques (e. g., dual-wire technique, pancreatic duct stenting, precut).

Results: The biliary cannulation rates were 81 % in the GWC group and 73 % in the CC group (P = n. s.). Following crossover, cannulation was successful in 8 % and 11 % of patients in the GWC and CC groups, respectively. With use of an alternative technique, the cannulation rates were 98 % in the GWC group and 96 % in the CC group, respectively. The rates of PEP were 5 % in the GWC group and 12 % in the CC group (P = 0.027). The post-interventional complication rates did not differ between the two groups.

Conclusion: GWC with the new wire guide is associated with a lower rate of PEP in comparison with the CC technique. Clinical trial reference number: NCT01771419.

No MeSH data available.


Related in: MedlinePlus