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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

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

Masci Enzo E Mangiavillano Benedetto B Luigiano Carmelo C Bizzotto Alessandra A Limido Eugenio E Cantù Paolo P Manes Gianpiero G Viaggi Paolo P Spinzi Giancarlo G Radaelli Franco F Mariani Alberto A Virgilio Clara C Alibrandi Angela A Testoni Pier Alberto PA

Endoscopy international open 20150915 5

<h4>Background</h4>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.<h4>Methods</h4>From June 2012 to December 201 ...[more]

PMID: 26528503

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Project description:BackgroundPeriampullary diverticula (PAD) often detected during endoscopic retrograde cholangiopancreatography (ERCP), and ERCP remains the primary approach to treating bile duct stones, and papilla cannulation plays a critical role in the success of ERCP. PAD can reduce the cannulation success rate. Needle knife precut greatly promoted the clinical application of precut incision. However, this approach also increases the risk of various adverse events. The present study aimed to compare the perioperative outcomes of pancreatic duct guide wire-assisted needle knife precut and conventional needle knife precut for PAD with difficult cannulation.MethodsA total of 230 cases of PAD with difficult cannulation of the duodenal papilla diagnosed by ERCP between June 2009 and December 2021 were retrospectively reviewed. The exclusion criteria were set as follows: patients with ERCP history, coagulopathy prothrombin time two times longer or platelet (PLT) count ≤70×109/L, or an inability to tolerate endoscopy due to severe heart/lung diseases. Pancreatic duct guide wire-assisted needle knife precut (Group A) was performed in 135 cases, and conventional needle knife precut (Group B) was performed in 95 cases. All clinical data were analyzed retrospectively. SPSS20.0 statistical software was used for the t-test and analysis of variance. P<0.05 was considered statistically significant.ResultsThe operating time of the needle knife precut was significantly shorter in Group A (18.44±6.65 min) compared with Group B (32.05±13.15 min, P<0.01). Moreover, the success rate of the cannulation was markedly higher in Group A (100%, 135/135) compared with Group B (78.9%, 75/95). Intraoperative complications occurred in 15 (11.1%) and 26 (27.4%) cases in Groups A and B, respectively (P<0.01). Postoperative complications occurred in 10 (7.4%) and 17 (17.9%) cases in Groups A and B, respectively (P<0.01). Our results showed notable differences in the operating time, success rate of cannulation, intraoperative complication rates, and postoperative complication rates between the two approaches.ConclusionsPancreatic duct guide wire-assisted needle knife precut appeared to be a safe and effective modality for PAD with difficult cannulation in the duodenal papilla.

Project description:AimsThis study was performed to compare the usability, efficiency, and safety of a modified angioplasty guidewire-assisted transseptal puncture (TSP) technique vs. the conventional approach in facilitating access into the left atrium during left atrial appendage occlusion (LAAO) procedures for the treatment of atrial fibrillation.Methods and resultsThe ADVANCE-LAAO trial (Angioplasty Guidewire-Assisted vs. Conventional Transseptal Puncture for Left Atrial Appendage Occlusion) was an investigator-initiated, prospective, multicentre, randomized controlled trial (NCT05125159). Patients with atrial fibrillation who underwent LAAO were prospectively enrolled from four centres and randomly assigned to an angioplasty guidewire-assisted TSP group (n = 131) or to a conventional Brockenbrough needle TSP group (n = 132). The primary endpoint was the one-time success rate of TSP. We also analysed the TSP procedure time, failure rate of the assigned TSP type, radiation dose, contrast dose, and procedural complications in both groups. All patients in the guidewire-assisted group underwent successful TSP, whereas five in the standard conventional group switched to the guidewire-assisted approach. The guidewire-assisted puncture improved the one-time success rate (92.4 vs. 77.3%, P = 0.001), shortened the TSP procedure time (109.2 ± 48.2 vs. 120.5 ± 57.6 s, P = 0.023), and tended to have a higher rate of good coaxial orientation of the sheath with the left atrial appendage during the LAAO procedure (66.4 vs. 54.5%, P = 0.059). No TSP-related complications occurred in the guidewire-assisted TSP group, whereas two complications occurred in the conventional TSP group. There was no significant difference in the failure rate of the assigned TSP type, the total procedure time, the total radiation dose, the rate of successful LAAO implantation, or the procedural complication rate between the two groups (all P > 0.05).ConclusionThis study confirmed that angioplasty guidewire-assisted puncture can effectively improve the success rate of TSP during LAAO procedures. This novel technique has high potential for application in interventional therapies requiring TSP.

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

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

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