Comparison between loop-tip guidewire-assisted and conventional endoscopic cannulation in high risk patients
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 atra...
| Main Authors: | , , , , , , , , , , , , , |
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| Format: | Article |
| Language: | English |
| Published: |
Georg Thieme Verlag KG
2015-09-01
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| Series: | Endoscopy International Open |
| Online Access: | http://www.thieme-connect.de/DOI/DOI?10.1055/s-0034-1392879 |
| _version_ | 1828834036622032896 |
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| author | Enzo Masci Benedetto Mangiavillano Carmelo Luigiano Alessandra Bizzotto Eugenio Limido Paolo Cantù Gianpiero Manes Paolo Viaggi Giancarlo Spinzi Franco Radaelli Alberto Mariani Clara Virgilio Angela Alibrandi Pier Alberto Testoni |
| author_facet | Enzo Masci Benedetto Mangiavillano Carmelo Luigiano Alessandra Bizzotto Eugenio Limido Paolo Cantù Gianpiero Manes Paolo Viaggi Giancarlo Spinzi Franco Radaelli Alberto Mariani Clara Virgilio Angela Alibrandi Pier Alberto Testoni |
| author_sort | Enzo Masci |
| collection | DOAJ |
| description | 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 |
| first_indexed | 2024-12-12T17:31:56Z |
| format | Article |
| id | doaj.art-bbebbb799d534967864165cf152ca327 |
| institution | Directory Open Access Journal |
| issn | 2364-3722 2196-9736 |
| language | English |
| last_indexed | 2024-12-12T17:31:56Z |
| publishDate | 2015-09-01 |
| publisher | Georg Thieme Verlag KG |
| record_format | Article |
| series | Endoscopy International Open |
| spelling | doaj.art-bbebbb799d534967864165cf152ca3272022-12-22T00:17:21ZengGeorg Thieme Verlag KGEndoscopy International Open2364-37222196-97362015-09-010305E464E47010.1055/s-0034-1392879Comparison between loop-tip guidewire-assisted and conventional endoscopic cannulation in high risk patientsEnzo Masci0Benedetto Mangiavillano1Carmelo Luigiano2Alessandra Bizzotto3Eugenio Limido4Paolo Cantù5Gianpiero Manes6Paolo Viaggi7Giancarlo Spinzi8Franco Radaelli9Alberto Mariani10Clara Virgilio11Angela Alibrandi12Pier Alberto Testoni13Gastrointestinal Endoscopy Unit, San Paolo University Hospital, University of Milan, Milan, ItalyGastrointestinal Endoscopy Unit, San Paolo University Hospital, University of Milan, Milan, ItalyUnit of Gastroenterology and Digestive Endoscopy, ARNAS Garibaldi, Catania, ItalyGastrointestinal Endoscopy Unit, San Paolo University Hospital, University of Milan, Milan, ItalyDigestive Endoscopy Unit, Hospital of Busto Arsizio, Busto Arsizio, Varese, ItalyGastroenterology Department, University of Milan, IRCCS Fondazione Policlinico, Milan, ItalyUnit of Digestive Endoscopy, University Hospital L. Sacco, Milan, ItalyGastrointestinal Endoscopy Unit, San Paolo University Hospital, University of Milan, Milan, ItalyGastroenterology Unit, Valduce Hospital, Como, ItalyGastroenterology Unit, Valduce Hospital, Como, ItalyDivision of Gastroenterology and Gastrointestinal Endoscopy, Vita-Salute San Raffaele University, Scientific Institute San Raffaele, Milan, Italy Unit of Gastroenterology and Digestive Endoscopy, ARNAS Garibaldi, Catania, ItalyDepartment of Statistics, University of Messina, Messina, ItalyDivision of Gastroenterology and Gastrointestinal Endoscopy, Vita-Salute San Raffaele University, Scientific Institute San Raffaele, Milan, Italy 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: NCT01771419http://www.thieme-connect.de/DOI/DOI?10.1055/s-0034-1392879 |
| spellingShingle | Enzo Masci Benedetto Mangiavillano Carmelo Luigiano Alessandra Bizzotto Eugenio Limido Paolo Cantù Gianpiero Manes Paolo Viaggi Giancarlo Spinzi Franco Radaelli Alberto Mariani Clara Virgilio Angela Alibrandi Pier Alberto Testoni Comparison between loop-tip guidewire-assisted and conventional endoscopic cannulation in high risk patients Endoscopy International Open |
| title | Comparison between loop-tip guidewire-assisted and conventional endoscopic cannulation in high risk patients |
| title_full | Comparison between loop-tip guidewire-assisted and conventional endoscopic cannulation in high risk patients |
| title_fullStr | Comparison between loop-tip guidewire-assisted and conventional endoscopic cannulation in high risk patients |
| title_full_unstemmed | Comparison between loop-tip guidewire-assisted and conventional endoscopic cannulation in high risk patients |
| title_short | Comparison between loop-tip guidewire-assisted and conventional endoscopic cannulation in high risk patients |
| title_sort | comparison between loop tip guidewire assisted and conventional endoscopic cannulation in high risk patients |
| url | http://www.thieme-connect.de/DOI/DOI?10.1055/s-0034-1392879 |
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