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

• Published in: Endoscopy International Open Vol. 3; no. 5; pp. E464 - E470
• Main Authors: Masci, Enzo, Mangiavillano, Benedetto, Luigiano, Carmelo, Bizzotto, Alessandra, Limido, Eugenio, Cantù, Paolo, Manes, Gianpiero, Viaggi, Paolo, Spinzi, Giancarlo, Radaelli, Franco, Mariani, Alberto, Virgilio, Clara, Alibrandi, Angela, Testoni, Pier Alberto
• Format: Journal Article
• Language: English
• Published: Stuttgart · New York Georg Thieme Verlag KG 01.10.2015
• Subjects: Original article
• ISSN: 2364-3722; 2196-9736
• DOI: 10.1055/s-0034-1392879

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