A prospective randomized study of loop-tip versus straight-tip guidewire in wire-guided biliary cannulation

Area of Science:

• Gastroenterology
• Endoscopic Retrograde Cholangiopancreatography (ERCP)
• Medical Devices

Background:

• Wire-guided cannulation enhances selective biliary access success rates.
• Loop-tip guidewires (LGW) may offer less traumatic biliary access due to their design.
• Conventional straight-tip guidewires (SGW) are widely used for biliary cannulation.

Purpose of the Study:

• To compare the efficacy of LGW versus SGW in achieving successful selective biliary cannulation.
• To evaluate the rate of unintentional pancreatic duct cannulation with LGW and SGW.
• To assess the incidence of post-ERCP pancreatitis between the two guidewire groups.

Main Methods:

• A randomized controlled trial involving 192 patients with a naïve papilla undergoing wire-guided biliary cannulation.
• Patients were randomized into two groups: LGW (n=96) and SGW (n=96).
• Cannulation success and complications were recorded within the first 10 minutes of the procedure.

Main Results:

• No significant difference in primary successful biliary cannulation rates between LGW (86.5%) and SGW (77.1%) groups (p=0.134).
• Significantly lower rates of unintentional pancreatic duct cannulation with LGW (14.6%) compared to SGW (28.1%) (p=0.034).
• Lower mean number of pancreatic duct cannulations in the LGW group (0.2) versus SGW group (0.6) (p=0.007).

Conclusions:

• LGW demonstrates comparable biliary cannulation rates to conventional SGW.
• LGW use is associated with a reduced risk of unintentional pancreatic duct cannulation during ERCP.
• No significant difference in post-ERCP pancreatitis rates was observed between the groups.