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Related Concept Videos

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Guide Wire Selection (Straight vs. Angled) in Endoscopic Retrograde Cholangiopancreatography Using a Normal Contrast

Takumi Maki1,2,3, Atsushi Irisawa1,3, Akira Yamamiya3

  • 1Department of Gastroenterology, Aizu Medical Center, Fukushima Medical University, 21-2 Kawahigashi Aizuwakamatsu, Fukushima 969-3482, Japan.

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Summary

Angled-tip guidewires (AGW) significantly improve selective biliary cannulation success rates during ERCP compared to straight-tip guidewires (SGW) when used by trainees. This technique enhances procedural outcomes without increasing pancreatitis risk.

Keywords:
endoscopic retrograde cholangiopancreatographytraineewire-guided cannulation

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Area of Science:

  • Gastroenterology
  • Endoscopic Procedures
  • Medical Device Technology

Background:

  • Wire-guided cannulation (WGC) is a key technique in ERCP to improve selective biliary cannulation and reduce post-ERCP pancreatitis (PEP).
  • The choice of guidewire, specifically angled-tip (AGW) versus straight-tip (SGW), may influence cannulation success rates, particularly when performed by trainees.

Purpose of the Study:

  • To compare the effectiveness of angled-tip guidewires (AGW) versus straight-tip guidewires (SGW) for biliary cannulation via WGC.
  • To evaluate the impact of guidewire type on selective biliary cannulation success rates and post-ERCP pancreatitis (PEP) incidence in a trainee setting.

Main Methods:

  • A prospective, single-center, randomized controlled trial involving 57 patients undergoing ERCP.
  • Patients were randomly assigned to initiate selective biliary cannulation using either an AGW or an SGW for 7 minutes.
  • A cross-over method was employed, allowing the use of the alternative guidewire for an additional 7 minutes if initial cannulation failed.

Main Results:

  • The overall selective biliary cannulation success rate over 14 minutes was significantly higher with AGW compared to SGW (57.8% vs. 34.3%, p=0.04).
  • AGW demonstrated a significantly higher success rate during the second 7-minute segment (36.4% vs. 0%, p=0.04), indicating improved performance after initial attempts.
  • No significant differences in adverse events, including pancreatitis, were observed between the AGW and SGW groups.

Conclusions:

  • Angled-tip guidewires (AGW) are recommended for wire-guided cannulation (WGC) in ERCP procedures performed by trainees.
  • The use of AGW enhances the success rate of selective biliary cannulation, potentially improving procedural efficiency and outcomes.