Biliary cannulation with contrast and guide-wire versus exclusive guide-wire: A prospective, randomized, double-blind trial.
Pancreatology
; 21(2): 459-465, 2021 Mar.
Article
em En
| MEDLINE
| ID: mdl-33526383
ABSTRACT
BACKGROUND:
The use of exclusive guide-wire cannulation (e-GW) instead of contrast injection reduces post-ERCP pancreatitis (PEP) and pre-cutting and increases cannulation rate. Herein, we intend to compare e-GW with the hybrid technique (GW-C and/or contrast injection).METHODS:
Prospective single-center randomized comparative study, which included all patients referred to ERCP to our unit. Patients with non-naïve papilla; previous ERCP; direct infundibulotomy, ampullectomy, Billroth II gastrectomy or pancreatic sphincterotomy and patients lost to follow up were excluded.RESULTS:
727 consecutive patients were assessed. Of these, 588 naïve papilla patients were included and randomized to receive e-GW (nâ¯=â¯299) or GW-C (nâ¯=â¯289) for selective biliary cannulation. The mean age was 60.3 years and 60.5% were women. PEP occurred in 15(5%) cases in e-GW group and 9(3.1%) in the GW-C group (pâ¯=â¯0.29). Time to reach deep cannulation was faster in the latter group (75%â¯<â¯5â¯min vs. 50.2%â¯<â¯5â¯min, p<0.001). > 10â¯min until cannulation was observed in 21% vs. 10% of the ERCPs (groups e-GW and GW-C, respectively, pâ¯<â¯0.001). Total ERCP time was also shorter in the GW-C group (12 vs. 10â¯min; pâ¯<â¯0.001). Pre-cut (23.8 vs.11.8%, pâ¯<â¯0.001) and pancreatic sphincterotomy as a pre-cut technique (15.8 vs. 5.6%, pâ¯<â¯0.001) were used more frequently in the e-GW group.CONCLUSIONS:
Compared to exclusive G-W- assisted biliary cannulation, the hybrid technique did not significantly reduce the PEP rate, however it promoted faster cannulation and, consequently, reduced the total procedure time and the use of pre-cut techniques.Palavras-chave
Texto completo:
1
Coleções:
01-internacional
Base de dados:
MEDLINE
Assunto principal:
Pancreatopatias
/
Pancreatite
/
Ácidos Tri-Iodobenzoicos
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Colangiopancreatografia Retrógrada Endoscópica
Tipo de estudo:
Clinical_trials
/
Etiology_studies
Limite:
Aged
/
Female
/
Humans
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Male
/
Middle aged
Idioma:
En
Revista:
Pancreatology
Ano de publicação:
2021
Tipo de documento:
Article