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

Authors
Hwang, JC  | Yoo, BM  | Yang, MJ  | Lee, YK | Lee, JY | Lim, K | Noh, CK  | Cho, HJ  | Kim, SS  | Kim, JH
Citation
Surgical endoscopy, 32(4). : 1708-1713, 2018
Journal Title
Surgical endoscopy
ISSN
0930-27941432-2218
Abstract
BACKGROUND: Wire-guided cannulation has been widely accepted as a useful technique for achieving selective biliary access because it has significantly increased the success rate of biliary cannulation compared with conventional contrast-assisted cannulation. Unlike conventional guidewires with a straight tip, a loop-tip guidewire (LGW) has a closed distal loop that may facilitate less traumatic access through the epithelial folds of the intra-duodenal biliary segments. The aim of this study was to compare the performance of a LGW with a straight-tip guidewire (SGW) in achieving successful selective biliary cannulation.
METHODS: From December 2014 to December 2015, we performed 192 wire-guided biliary cannulations for a naive papilla in a randomized controlled trial. Patients were randomly assigned to the LGW group (n = 96) or the SGW group (n = 96). Our study protocol did not include crossover to the other guidewire arm if randomized wire-guided cannulation proved unsuccessful within the first 10 min.
RESULTS: There was no significant difference in primary successful biliary cannulation between the two groups (LGW group: 86.5%: SGW group: 77.1%: p = 0.134). The rate and the mean number of unintentional pancreatic duct cannulations during wire-guided biliary cannulation were significantly lower in the LGW group than in the SGW group (LGW group: 14.6%: SGW group: 28.1%: p = 0.034: LGW group: 0.2 +/- 0.5: SGW group: 0.6 +/- 1.3: p = 0.007). Post-ERCP pancreatitis developed in 5.2% of patients in the LGW group and 8.3% of patients in the SGW group (p = 0.567).
CONCLUSIONS: The biliary cannulation rate of the LGW was not significantly different from those of conventional guidewires. Use of the LGW was associated with a lower rate of unintentional pancreatic duct cannulation during wire-guided biliary cannulation than use of the SGW.
Keywords
DOI
10.1007/s00464-017-5851-z
PMID
28916891
Appears in Collections:
Journal Papers > School of Medicine / Graduate School of Medicine > Gastroenterology
Ajou Authors
김, 순선  |  김, 진홍  |  노, 충균  |  양, 민재  |  유, 병무  |  조, 효정  |  황, 재철
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