Endosc Int Open 2015; 03(05): E464-E470
DOI: 10.1055/s-0034-1392879
Original article
© Georg Thieme Verlag KG Stuttgart · New York

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

Enzo Masci
1  Gastrointestinal Endoscopy Unit, San Paolo University Hospital, University of Milan, Milan, Italy
,
Benedetto Mangiavillano
1  Gastrointestinal Endoscopy Unit, San Paolo University Hospital, University of Milan, Milan, Italy
,
Carmelo Luigiano
2  Unit of Gastroenterology and Digestive Endoscopy, ARNAS Garibaldi, Catania, Italy
,
Alessandra Bizzotto
1  Gastrointestinal Endoscopy Unit, San Paolo University Hospital, University of Milan, Milan, Italy
,
Eugenio Limido
3  Digestive Endoscopy Unit, Hospital of Busto Arsizio, Busto Arsizio, Varese, Italy
,
Paolo Cantù
4  Gastroenterology Department, University of Milan, IRCCS Fondazione Policlinico, Milan, Italy
,
Gianpiero Manes
5  Unit of Digestive Endoscopy, University Hospital L. Sacco, Milan, Italy
,
Paolo Viaggi
1  Gastrointestinal Endoscopy Unit, San Paolo University Hospital, University of Milan, Milan, Italy
,
Giancarlo Spinzi
6  Gastroenterology Unit, Valduce Hospital, Como, Italy
,
Franco Radaelli
6  Gastroenterology Unit, Valduce Hospital, Como, Italy
,
Alberto Mariani
7  Division of Gastroenterology and Gastrointestinal Endoscopy, Vita-Salute San Raffaele University, Scientific Institute San Raffaele, Milan, Italy
,
Clara Virgilio
2  Unit of Gastroenterology and Digestive Endoscopy, ARNAS Garibaldi, Catania, Italy
,
Angela Alibrandi
8  Department of Statistics, University of Messina, Messina, Italy
,
Pier Alberto Testoni
7  Division of Gastroenterology and Gastrointestinal Endoscopy, Vita-Salute San Raffaele University, Scientific Institute San Raffaele, Milan, Italy
› Author Affiliations
Further Information

Publication History

submitted07 April 2015

accepted after revision26 June 2015

Publication Date:
15 September 2015 (online)

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