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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

 Contrast-assisted cannulation without use of a guidewire.
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FI261-3:  Contrast-assisted cannulation without use of a guidewire.

Mentions: Contrast-assisted cannulation group: In the CC group, the sphincterotome was used to cannulate the CBD directly, with its position adjusted to the correct axis for bile duct cannulation (Fig. 3). If direct cannulation was not achieved, contrast opacifications were performed to visualize the CBD, and the sphincterotome was deeply reinserted under cholangiographic guidance. Such attempts were continued for 5 minutes or for a maximum of three unintentional PD opacifications or cannulations. If the procedure did not succeed with the CC method at the first attempt, patients were crossed over to the GWC technique with the loop-tip guidewire, and the endoscopist attempted to cannulate for no longer than 5 minutes or five accidental main PD cannulations.


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)

 Contrast-assisted cannulation without use of a guidewire.
© Copyright Policy
Related In: Results  -  Collection

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

FI261-3:  Contrast-assisted cannulation without use of a guidewire.
Mentions: Contrast-assisted cannulation group: In the CC group, the sphincterotome was used to cannulate the CBD directly, with its position adjusted to the correct axis for bile duct cannulation (Fig. 3). If direct cannulation was not achieved, contrast opacifications were performed to visualize the CBD, and the sphincterotome was deeply reinserted under cholangiographic guidance. Such attempts were continued for 5 minutes or for a maximum of three unintentional PD opacifications or cannulations. If the procedure did not succeed with the CC method at the first attempt, patients were crossed over to the GWC technique with the loop-tip guidewire, and the endoscopist attempted to cannulate for no longer than 5 minutes or five accidental main PD cannulations.

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