Dye-free Wire-guided Cannulation of the Biliary Tree During ERCP is Associated With High Success and Low Complication Rates

Adler, Douglas G.; Verma, Dharmendra; Hilden, Kristen; Chadha, Romil; Thomas, Kristen

doi:10.1097/mcg.0b013e3181aacbd1

Cited by 32 publications

(18 citation statements)

References 34 publications

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“…Subgroup analysis with meta-regression showed no statistically significant differences between academic and community settings, prospective and retrospective study designs, and trainee participation on success of bile duct cannulation, precut utilization, and common bile duct stone extraction (insufficient observations/variance for pancreatic duct cannulation and biliary stent placement). The results for each quality indicator are tabulated in Tables 1-5 (refs 5-55). …”

Section: Resultsmentioning

confidence: 99%

Intraprocedural Quality in Endoscopic Retrograde Cholangiopancreatography: A Meta-Analysis

DeBenedet

Elmunzer

McCarthy

et al. 2013

American Journal of Gastroenterology

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OBJECTIVES In 2006, the American College of Gastroenterology (ACG)/the American Society for Gastrointestinal Endoscopy (ASGE) Taskforce on Quality in Endoscopy published quality indicators for the major gastrointestinal procedures. Our primary aim was to use the published literature to assess current endoscopic retrograde cholangiopancreatography (ERCP) intraprocedural performance and compare it to the targets set by the ACG/ASGE taskforce. Our secondary aim was to determine whether performance varies across different health-care settings (academic and community), study designs (prospective and retrospective), and trainee participation. METHODS A PubMed and EMBASE literature search from 1/1/2006 to 2/1/2013 was conducted. Articles were selected based on title, abstract, full text, and reporting of success rates for the intraprocedural quality indicators. Success rates, represented as numerical proportions, were collected from each study. For each success rate, a standard error and a 95% confidence interval (CI) was calculated. A random-effects meta-analysis model was used to weight each study, and a cumulative, weighted success rate (or effect size) for each indicator was determined. Random-effects meta-regression was then used to examine the impact of study setting, design, and trainee involvement on each quality indicator. RESULTS A total of 8,005 articles were initially retrieved. Following the application of predefined criteria, 52 articles remained. The cumulative, weighted bile duct cannulation success rate was 89.3% (95% CI 0.866–0.919); pancreatic duct cannulation was 85.0% (95% CI 0.813–0.886); precut utilization rate was 10.5% (95% CI 0.087–0.123); common bile duct stone extraction rate was 88.3% (95% CI 0.825–0.941); and the rate of successful biliary stenting below the common bile duct bifurcation was 97.5% (95% CI 0.967–0.984). Subgroup analysis with meta-regression showed no statistically significant differences between academic and community settings, prospective and retrospective study designs, and trainee participation on success across bile duct cannulation, precut utilization, and common bile duct stone extraction (insufficient observations/variance for pancreatic duct cannulation and biliary stent placement). CONCLUSIONS ERCP intraprocedural quality is in good standing. On the basis of this analysis, the two targets that could be potentially revised are precut utilization and biliary stenting. This analysis was confined to the published literature and therefore, in general, reflects the ERCP performance of institutions, primarily academic, that are conducting clinical research. Thus, it is difficult to generalize this performance assessment to the broader ERCP community as a whole.

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Section: Resultsmentioning

confidence: 99%

Intraprocedural Quality in Endoscopic Retrograde Cholangiopancreatography: A Meta-Analysis

DeBenedet

Elmunzer

McCarthy

et al. 2013

American Journal of Gastroenterology

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“…The definition of “difficult cannulation” is our concern on the unusually high proportion of this group in other studies 15,16 . In high‐volume centers, the success rate in deep BC should be close to 90% 22,23 . Maeda et al 15 .…”

Section: Discussionmentioning

confidence: 99%

Success rate and cannulation time between precut sphincterotomy and double‐guidewire technique in truly difficult biliary cannulation

Angsuwatcharakon

Rerknimitr

Ridtitid

et al. 2012

J of Gastro and Hepatol

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“…In one recent series, 795 (99%) of 801 ERCPs were performed without contrast to initially identify access to the common bile duct (CBD). The pancreatitis rate in this series was 1.3%, as was guidewire perforation of the bile duct, which also occurred infrequently (Adler et al, 2010). An additional way of gaining access to the difficult-to-cannulate CBD is to selectively place a pancreatic duct stent first and then attempt wire-guided cannulation of the bile duct.…”

mentioning

confidence: 50%

Direct cholangiography

Getrajdman¹,

Kurtz²

2012

Blumgart's Surgery of the Liver, Pancreas and Biliary Tract

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Dye-free Wire-guided Cannulation of the Biliary Tree During ERCP is Associated With High Success and Low Complication Rates

Abstract: In this large retrospective case series, a high success rate of DBC was achieved by using dye-free guidewire techniques. This technique has associated lower rates of complications in comparison to those reported earlier.

Cited by 32 publications

References 34 publications

Intraprocedural Quality in Endoscopic Retrograde Cholangiopancreatography: A Meta-Analysis

Intraprocedural Quality in Endoscopic Retrograde Cholangiopancreatography: A Meta-Analysis

Success rate and cannulation time between precut sphincterotomy and double‐guidewire technique in truly difficult biliary cannulation

Direct cholangiography

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