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

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.

SUBMITTER: Masci E 

PROVIDER: S-EPMC4612233 | biostudies-literature | 2015 Oct

REPOSITORIES: biostudies-literature