Wire‐guided biliary cannulation technique does not reduce the risk of post‐ERCP pancreatitis: Multicenter randomized controlled trial. Issue 3 (19th September 2012)

• Record Type: Journal Article
• Authors: Kobayashi, Go; Fujita, Naotaka; Imaizumi, Kazuomi; Irisawa, Atsushi; Suzuki, Masaki; Murakami, Akihiko; Oana, Shuhei; Makino, Naohiko; Komatsuda, Tomoya; Yoneyama, Kazuo
• Is Part Of: Digestive endoscopy. Volume 25:Issue 3(2013:May)
• Page Start: 295
• Page End: 302
• Publication Date: 2012-09-19
• Subjects: Digestive organs -- Diseases -- Periodicals; Digestive organs -- Diseases -- Diagnosis -- Periodicals; Endoscopy -- Periodicals; Digestive System Diseases -- diagnosis -- Periodicals; Digestive System Diseases -- therapy -- Periodicals; Endoscopy -- Periodicals; 616.3
• DOI: 10.1111/j.1443-1661.2012.01372.x
• Languages: English
• ISSNs: 0915-5635

Abstract

<abstract abstract-type="main"> <title> <x xml:space="preserve">Abstract</x> </title> <sec id="den1372-sec-0001" sec-type="section"> <title>Aim</title> <p>To evaluate the effect of wire‐guided biliary cannulation (WGC) on the prevention of post‐endoscopic retrograde cholangiopancreatography (ERCP) pancreatitis (PEP).</p> </sec> <sec id="den1372-sec-0002" sec-type="section"> <title>Methods</title> <p>We investigated the impact of the WGC technique on the incidence of PEP by comparing the conventional cannulation (CC) technique in selective bile duct cannulation during ERCP with a cross‐over design in a prospective multicenter randomized controlled trial and the potential risk factors for PEP. This involved six tertiary referral centers and three university hospitals. A total of 322 patients with indications for ERCP requiring selective biliary cannulation were enrolled from April 2008 to March 2009.</p> </sec> <sec id="den1372-sec-0003" sec-type="section"> <title>Results</title> <p>One hundred and sixty‐three patients were assigned to the WGC group and 159 to the CC group. The incidence of PEP was the same between the groups (6.1% <italic>vs</italic> 6.3%, <italic>P</italic> = 0.95). Primary successful biliary cannulation was achieved in 136 patients (83%) in the WGC group and in 138 (87%) in the CC group (<italic>P</italic> = 0.40). The mean time required for primary successful biliary cannulation was 7.4 ± 8.3 min and 7.2 ± 7.9 min, respectively (<italic>P</italic> = 0.83). Multivariate analysis demonstrated that accidental guidewire insertions and unintended injections of contrast into the main pancreatic duct were the only independent risk factors for PEP (<italic>P</italic> = 0.001, relative risk [RR]: 8.70, 95% confidence interval [CI]: 2.46–30.81).</p> </sec> <sec id="den1372-sec-0004" sec-type="section"> <title>Conclusion</title> <p>The WGC technique does not reduce the risk of PEP and also does not improve the success rate of selective bile duct cannulation.</p> </sec> </abstract>