Comparison of two types of guidewires for malignant hilar biliary obstruction by endoscopic retrograde cholangiopancreatography: a randomized controlled trial

Aims There is insufficient information on the optimal guidewire for managing malignant hilar biliary obstruction (MHBO). Therefore, a newly designed 0.025-inch guidewire was compared with the conventional 0.035-inch guidewire for selective cannulation of both intrahepatic ducts (IHDs) in patients with MHBO ([Fig. 1]).

Fig. 1

Methods Patients were randomly enrolled into the curved type newly designed 0.025-inch guidewire group (0.025 group) or curved type conventional 0.035-inch guidewire group (0.035 group). The primary outcome was the selective cannulation rate of IHD. If the assigned guidewire failed to pass the stricture within 5 minutes, the crossover usage of the guidewire was done. If the crossover guidewire failed to cross the stricture within the next 5 minutes, it was judged as failed selective cannulation of both IHDs [1] [2] [3] [4] [5] [6] [7] [8] [9] [10] [11] [12].

Results Ninety patients were enrolled (0.025 group, n=47; 0.035 group, n=43). Four patients (8.5%) in the 0.025 group failed to cannulate the IHD and changed to the conventional 0.035-inch guidewire as a second attempt; all four failed to cross the stricture with the 0.035-inch guidewire. Eleven patients (25.6%) in the 0.035 group failed to achieve selective cannulation of IHD and changed to the 0.025-inch guidewire; ten (10/11, 90.9%) crossed the stricture with the newly designed 0.025-inch guidewire. selective cannulation rate of IHD was significantly higher in the 0.025 group (95.1% vs. 85.5%, P=0.043).

Conclusions The 0.025 group has a higher success rate of selective cannulation of both IHDs in MHBO than the 0.035 group.

Publikationsverlauf

Artikel online veröffentlicht:
14. April 2023

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