A prospective randomized study of loop-tip versus straight-tip guidewire in wire-guided biliary cannulation.
Surg Endosc
; 32(4): 1708-1713, 2018 04.
Article
in En
| MEDLINE
| ID: mdl-28916891
ABSTRACT
BACKGROUND:
Wire-guided cannulation has been widely accepted as a useful technique for achieving selective biliary access because it has significantly increased the success rate of biliary cannulation compared with conventional contrast-assisted cannulation. Unlike conventional guidewires with a straight tip, a loop-tip guidewire (LGW) has a closed distal loop that may facilitate less traumatic access through the epithelial folds of the intra-duodenal biliary segments. The aim of this study was to compare the performance of a LGW with a straight-tip guidewire (SGW) in achieving successful selective biliary cannulation.METHODS:
From December 2014 to December 2015, we performed 192 wire-guided biliary cannulations for a naïve papilla in a randomized controlled trial. Patients were randomly assigned to the LGW group (n = 96) or the SGW group (n = 96). Our study protocol did not include crossover to the other guidewire arm if randomized wire-guided cannulation proved unsuccessful within the first 10 min.RESULTS:
There was no significant difference in primary successful biliary cannulation between the two groups (LGW group 86.5%; SGW group 77.1%; p = 0.134). The rate and the mean number of unintentional pancreatic duct cannulations during wire-guided biliary cannulation were significantly lower in the LGW group than in the SGW group (LGW group 14.6%; SGW group 28.1%; p = 0.034; LGW group 0.2 ± 0.5; SGW group 0.6 ± 1.3; p = 0.007). Post-ERCP pancreatitis developed in 5.2% of patients in the LGW group and 8.3% of patients in the SGW group (p = 0.567).CONCLUSIONS:
The biliary cannulation rate of the LGW was not significantly different from those of conventional guidewires. Use of the LGW was associated with a lower rate of unintentional pancreatic duct cannulation during wire-guided biliary cannulation than use of the SGW.Key words
Full text:
1
Database:
MEDLINE
Main subject:
Postoperative Complications
/
Catheterization
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Cholangiopancreatography, Endoscopic Retrograde
Type of study:
Clinical_trials
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Observational_studies
/
Risk_factors_studies
Limits:
Adult
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Aged
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Female
/
Humans
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Male
/
Middle aged
Language:
En
Year:
2018
Type:
Article