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Biliary cannulation with contrast and guide-wire versus exclusive guide-wire: A prospective, randomized, double-blind
Julio Pereira-Lima1, Ivan David Arciniegas Sanmartin1, Guilherme Watte2
1Department of Gastroenterology and Hepatology, Division of Endoscopy, Santa Casa Hospital, Federal University of Health Sciences of Porto Alegre (UFCSPA), Porto Alegre, Brazil.
The hybrid technique for ERCP cannulation did not significantly lower post-ERCP pancreatitis (PEP) rates compared to exclusive guide-wire (e-GW) use. However, it did result in faster cannulation times and reduced overall procedure duration.
Area of Science:
- Gastroenterology
- Endoscopic Retrograde Cholangiopancreatography (ERCP)
- Biliary Cannulation Techniques
Background:
- Exclusive guide-wire (e-GW) cannulation is proposed to reduce post-ERCP pancreatitis (PEP) and pre-cutting, while increasing cannulation rates.
- The hybrid technique involves guide-wire and contrast injection for selective biliary cannulation.
Purpose of the Study:
- To compare the efficacy and safety of the exclusive guide-wire (e-GW) technique versus the hybrid technique (guide-wire and contrast injection) for selective biliary cannulation during ERCP.
- To evaluate differences in post-ERCP pancreatitis (PEP) rates, cannulation success, procedure time, and the need for pre-cut techniques between the two methods.
Main Methods:
- A prospective, single-center randomized comparative study was conducted.
- 588 patients with naïve papilla undergoing ERCP were randomized to either e-GW (n=299) or the hybrid technique (GW-C, n=289).
- Exclusion criteria included non-naïve papilla, prior ERCP, specific surgical histories, and loss to follow-up.
Main Results:
- Post-ERCP pancreatitis (PEP) rates were similar between groups: 5% for e-GW and 3.1% for GW-C (p=0.29).
- The hybrid technique (GW-C) demonstrated significantly faster deep cannulation (75% < 5 min vs. 50.2% < 5 min, p<0.001) and shorter total ERCP procedure times (10 min vs. 12 min, p<0.001).
- Pre-cut techniques, including pancreatic sphincterotomy, were used more frequently in the e-GW group (23.8% vs. 11.8%, p<0.001).
Conclusions:
- The hybrid technique did not significantly reduce PEP rates compared to exclusive guide-wire cannulation.
- The hybrid technique facilitated faster cannulation, leading to reduced total procedure time and decreased utilization of pre-cut techniques.
- These findings suggest the hybrid approach may offer advantages in procedural efficiency without compromising safety regarding PEP.
