Can wire-guided cannulation prevent post-ERCP pancreatitis? A prospective randomized trial

Lee, Tae Hoon; Park, Do Hyun; Park, Jiyoung; Kim, Yang Soo; Lee, Yeon Seon; Park, Jeong Hoon; Lee, Suck-Ho; Chung, Il‐Kwun; Kim, Hong Soo; Park, Sang‐Heum; Kim, Sun‐Joo

doi:10.1016/j.gie.2008.04.064

Cited by 135 publications

(152 citation statements)

References 22 publications

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“…The success rates of SBDC within 10 min among the 4 groups in this study constitute seemingly ordinary data compared with some RCTs [3][4][5]. However, the final success rate of SBDC was acceptable (92.8-95%).…”

Section: Discussionmentioning

confidence: 55%

“…Neither catheter type nor cannulation method had any significant effect on SBDC success rate. However, the SBDC and fluoroscopy times were significantly shorter in the with-GW group.The success rates of SBDC within 10 min among the 4 groups in this study constitute seemingly ordinary data compared with some RCTs [3][4][5]. However, the final success rate of SBDC was acceptable (92.8-95%).…”

mentioning

confidence: 55%

“…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%

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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: Discussionmentioning

confidence: 55%

mentioning

confidence: 55%

Section: Introductionmentioning

confidence: 99%

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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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“…Repeated contrast injections into the pancreatic duct should be avoided because of increased risk of acute pancreatitis [8,9] . The guide wire technique for bile duct cannulation may lower the likelihood of postERCP pancreatitis (PEP) compared to the contrast injection methods by avoiding unintentional pancreatic duct injection and reducing the need for precut sphincterotomy [4,10,11] . However, a conflicting study found no difference in the incidence of PEP and suggested that successful cannulation with fewer attempts at the papilla is a more important factor than whether guide wire or contrast is routinely used first to achieve biliary cannulation [12] .…”

Section: Commonly Used Techniquesmentioning

confidence: 99%

Advances in endoscopic retrograde cholangiopancreatography cannulation

Qayed

Reid²,

Willingham³

et al. 2010

WJGE

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Endoscopic retrograde cholangiopancreatography is an important tool in the diagnosis and treatment of pancreatobiliary diseases. A critical step in this pro cedure is deep cannulation of the bile duct as failure of cannulation generally results in an aborted procedure and failed intervention. Expert endoscopists usually achieve a high rate of successful cannulation while those less experienced typically have a much lower rate and a greater incidence of complications. Prolonged attempts at cannulation can result in significant morbidity to patients, anxiety for endoscopists, unnecessary radiation exposure and inefficient patient care. Here we review the most common endoscopic techniques used to achi eve selective biliary cannulation. Pharmacologic aids to cannulation are also discussed briefly in this review.

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“…Hence, it significantly decreases the risk of PEP compared to standard cannulation techniques using contrast alone which is obsolete now. 23,24 PGW placement: This technique is a new technique to gain access to the bile duct and to reduce the risk of PEP after failure of traditional techniques. The technique involves inserting a first guide wire deep into the PD.…”

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confidence: 99%

Post ERCP Pancreatitis: A Endoscopist’s Night Mare! An Insight with Literature Review

Sharma¹

2016

JLRDT

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Abbreviations: NSAIDs, non-steroidal anti-inflammatory drugs; PD, pancreatic duct; ERCP, endoscopic retrograde cholangiopancreatography; PEP, post-ercp pancreatitis; ULN, upper limit of normal; MRCP, magnetic resonance cholangiopancreatography; EUS, endoscopic ultrasonography; CBD, common bile Duct; SO, sphincter of oddi; PGW, pancreatic guide wire; GWs, guide wires IntroductionPost-ERCP Pancreatitis (PEP) is the most common complication of Endoscopic Retrograde Cholangiopancreatography (ERCP) resulting from mechanical injury by guide wire, papillary trauma from prolonged papillary manipulation, hydrostatic & chemical injury from contrast, enzymatic injury through activation of proteolytic enzyme, infection from contaminated scope/accessory and thermal injury. PEP is a worst night mare on the following day of ERCP. It has signifiant médical, social and economic bourden on patient and liability implications on endoscopist. PEP is most commonly defined as newly emerging or worsening of prior abdominal pain with a serum amylase level at least three times higher than the upper limits of normal within 24hours of ERCP. PEP can be mild, moderate, or severe according to requirement of admission or prolongation of planned admission. Prolongation of planned admission to two to three days occurs in mild PEP, three to ten days in moderate and more than ten days in severe PEP.Although PEP is reported to occur in 1-40% of cases, in prospective studies, it is reported to occur in 5-10% with 1% severe and 0.1% fatal cases.1 Serum amylase values less than 1.5times the upper limit of normal (ULN), obtained at 2-4hours post-ERCP, almost exclude PEP and value more than 3 or 5times the ULN at 4-6hours post ERCP have increasing positive predictive values for PEP. Patient-related risk factors for post ERCP pancreatitisRisk of post-ERCP pancreatitis is determined not only by the characteristics of the patient but also by endoscopic techniques or maneuvers. Patient-related risk factors include younger age, suspected sphincter of Oddi dysfunction, history of previous PEP, and absence of elevated serum bilirubin.3,4 Pancreatic contrast injection independently associated with pancreatitis risk, and risk increases with number of injections.3 It rapidly acinarized in pancreas, hence can't be retrieved back so it remain significant risk factor for PEP. Pancreatic sphincterotomy was found to be a risk factor for pancreatitis due to thermal injury but the risk of severe pancreatitis significantly reduced if pancreatic drainage done efficiently via a pancreatic stent. Pre cut papillotomy or accessotomy to gain access to the common bile duct has uniformly been associated with a higher risk of pancreatitis.3,4 This elevated risk emerges even after adjusting for difficulty of cannulation or early pre cut decreases PEP remain a matter of Debate.Balloon-dilation of the biliary sphincter is an alternative to sphincterotomy for the extraction of bile duct stones. It is associated with higher risk of PEP, although two randomized trials have shown compl...

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Can wire-guided cannulation prevent post-ERCP pancreatitis? A prospective randomized trial

Cited by 135 publications

References 22 publications

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

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

Advances in endoscopic retrograde cholangiopancreatography cannulation

Post ERCP Pancreatitis: A Endoscopist’s Night Mare! An Insight with Literature Review

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