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A prospective randomized study of thin versus regular-sized guide wire in wire-guided cannulation
Jorma Halttunen1, Leena Kylänpää
1Department of Gastrointestinal and General Surgery, Helsinki University Central Hospital, Haartmaninkatu 4, PL340, 00029 Helsinki, Finland. jorma.halttunen@hus.fi
Surgical Endoscopy
|December 15, 2012
Summary
The thickness of guide wires used during endoscopic retrograde cholangiopancreatography (ERCP) does not impact bile duct cannulation success rates or complication risks. This study found no significant difference between thin and regular-sized guide wires in ERCP procedures.
Area of Science:
- Gastroenterology
- Endoscopic Procedures
- Biliary Interventions
Background:
- Endoscopic retrograde cholangiopancreatography (ERCP) is crucial for diagnosing and managing pancreatobiliary disorders.
- Papillary trauma during ERCP can lead to post-ERCP pancreatitis (PEP).
- Investigating methods to minimize trauma and improve selective bile duct cannulation is essential.
Purpose of the Study:
- To evaluate if a thinner guide wire and sphincterotome combination reduces papillary trauma during ERCP.
- To determine if this combination facilitates selective bile duct cannulation.
- To assess the incidence of post-ERCP pancreatitis (PEP) with thinner versus regular-sized guide wires.
Main Methods:
- A randomized controlled trial involving 100 patients undergoing biliary cannulation.
- Patients were assigned to either a 0.025-inch or 0.035-inch guide wire and sphincterotome group.
- Data collected included cannulation success rates, accidental pancreatic duct wire passage, and post-ERCP complications.
Main Results:
- Primary cannulation success rate was 80%, with overall success near 100% using accessory techniques.
- No significant difference in primary cannulation rates between the 0.025-inch and 0.035-inch wire groups.
- PEP occurred in 2.0% of patients, with one case in each group. Postsphincterotomy bleeding occurred in 1.0%.
Conclusions:
- Guide wire thickness does not significantly influence the success rate of primary bile duct cannulation during ERCP.
- The choice of guide wire thickness (0.025-inch vs. 0.035-inch) does not appear to affect the risk of post-ERCP pancreatitis or other complications.
