A simple way of avoiding post-ERCP pancreatitis

Lella, F.; Bagnolo, F.; Colombo, Elena; Bonassi, U.

doi:10.1016/s0016-5107(04)00363-3

Cited by 168 publications

(161 citation statements)

References 28 publications

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“…Cannulations using a sphincterotome with wire-guided cannulation (WGC) instead of the conventional catheter, with contrast medium injection, are gradually performed in many countries. These new methods were reported to be superior to conventional techniques in terms of both success rate and the incidence of post-ERCP pancreatitis (PEP) in some randomized studies [1][2][3][4][5]. However, those studies were performed by either a single or, at most, two skilled endoscopists in a single center [1,2,4,5].…”

Section: Introductionmentioning

confidence: 99%

A multicenter, prospective, randomized study of selective bile duct cannulation performed by multiple endoscopists: the BIDMEN study

Kawakami

Maguchi

Mukai

et al. 2012

Gastrointestinal Endoscopy

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Background: Wire-guided cannulation (WGC) with a sphincterotome for selective bile duct cannulation (SBDC) has been reported to have a higher success rate and lower incidence of post-ERCP pancreatitis (PEP) than conventional methods in some randomized controlled trials (RCTs) that were both single-center and limited to only a few endoscopists.Objective: To estimate the difference in SBDC according to the method and catheter used in a multicenter and multi-endoscopist study. Design:A prospective multicenter RCT with a 2-by-2 factorial design. Setting: Fifteen referral endoscopy units.Patients: In total, 400 consecutive patients with naïve papilla who were candidates for ERCP were enrolled and randomized.Interventions: Patients were assigned to 4 groups according to combined catheter (sphincterotome (S) or catheter (C)) and method (with/without guidewire (GW)). Main Outcome Measurements:Success rate of SBDC in 10 min, time for SBDC, fluoroscopic time and incidence of complications. Results:There was no significant difference in SBDC success rate between with-and without-GW, between C and S, or between the 4 groups (C+GW, C, S+GW, and S). WGC had a tendency to significantly shorten cannulation and fluoroscopic times only in approximately 70% of patients in this study in whom SBDC was achieved in 10 min or less (P = 0.036 and 0.00004, respectively). All 4 groups resulted in similar outcomes in PEP (4%, 5.9%, 2%, and 2.1%, respectively).Limitations: Non-double-blinded study. Kawakami-4 4Conclusions: WGC appears to significantly shorten cannulation and fluoroscopic times.However, neither the method nor type of catheter used resulted in significant differences in either SBDC success rate or incidence of PEP in this RCT. Kawakami-5 5 Keywords:Wire-guided cannulation; Selective bile duct cannulation; Post-ERCP pancreatitis; Randomized controlled trial; Cannulation time; Fluoroscopic time; Radiation exposure time Kawakami-6 6 INTRODUCTIONBiliary cannulation is the most basic procedure for performing biliary interventions; however, no standard has been established to date. The success rates are considered to be related to 3 factors: the kind of catheter, cannulation method, and the skill of the endoscopist. The complication rates are also related to 3 factors: patient, procedure factors, and operator expertise. Cannulations using a sphincterotome with wire-guided cannulation (WGC) instead of the conventional catheter, with contrast medium injection, are gradually performed in many countries. These new methods were reported to be superior to conventional techniques in terms of both success rate and the incidence of post-ERCP pancreatitis (PEP) in some randomized studies [1][2][3][4][5]. However, those studies were performed by either a single or, at most, two skilled endoscopists in a single center [1,2,4,5]. Thus, these data cannot be generalized more widely.In these previous studies, 5° backward-oblique angle therapeutic duodenoscopes (BOAD) were used. In Japan, standard duodenoscopes have traditionally been 15° BOAD. Thu...

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Section: Introductionmentioning

confidence: 99%

A multicenter, prospective, randomized study of selective bile duct cannulation performed by multiple endoscopists: the BIDMEN study

Kawakami

Maguchi

Mukai

et al. 2012

Gastrointestinal Endoscopy

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“…Guidewire insertion into the bile duct improves the safety margin of a sphincterotomy by ensuring the incision of the biliary sphincter as intended. As mentioned before, this allows for repeated cannulation decreasing any risk of papillary injury if the papillotome becomes dislodged [12] . A search of the Maude database for all three shortwire system manufacturers was carried out and only adverse events regarding the Wallstent RX Biliary (Boston Scientific, Galway, Ireland) were listed.…”

Section: Safetymentioning

confidence: 95%

“…The studies to date have yielded conflicting results regarding the role of guidewire cannulation and prevention of PEP. Lella et al [12] conducted a prospective study with 400 patients randomized to either Group A with a guidewire used to access the pancreatic duct and endoscopic sphincterotomes, and Group B with a traditional catheter plus injection technique used. The rate of PEP was 0% in Group A versus 4.1% in Group B.…”

Section: Reddy Sc Et Al Ercp and Guidewiresmentioning

confidence: 99%

ERCP wire systems: The long and the short of it

Reddy¹,

Draganov²

2009

WJG

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Guidewires are routinely used at the time of endoscopic retrograde cholangiopancreatography (ERCP) to gain and maintain access to the desired duct and aid in the advancement of various devices. Limitations of the traditional long-wire systems have led to the introduction of three proprietary short-wire systems. These systems differ in many respects but share two main principles: They lock a shorter wire in position to allow advancement or removal of various devices without displacement of the wire and they all allow for physician control of the wire. In this comprehensive review, we describe the key features of the three currently available short-wire systems: RX, Fusion and V systems. We also focus on the potential benefits and drawbacks that accompany the short-wire concept as a whole and each specific system in particular. Although the available data are limited, it appears that the use of the short-wire systems lead to reduced procedure, fluoroscopy and device exchange times, decreased sedation requirements, improved wire stability and increased endoscopist control of the wire. Furthermore, the physician-controlled wire-guided cannulation has the potential to decrease ampullary trauma and the rate of post-ERCP pancreatitis. The short guidewire systems appear to be an improvement over the traditional long-wire systems but further studies directly comparing the two approaches are needed.

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“…However, several prospective studies (50)(51)(52) provided conflicting results as to whether the wire-guided cannulation technique reduces PEP risk compared with the standard method. Further RCTs are needed to confirm the effectiveness of this method.…”

Section: Endoscopic Proceduresmentioning

confidence: 99%