Comparison between loop-tip guidewire-assisted and conventional endoscopic cannulation in high risk patients

Abstract

Background: The guidewire biliary cannulation (GWC) technique may increase the cannulation rate and decrease the risk for post‐endoscopic retrograde cholangiopancreatography (ERCP) pancreatitis. The aim of our multicenter prospective randomized controlled trial was to determine if the use of an atraumatic loop‐tip guidewire reduces the rate of post‐ERCP pancreatitis (PEP) compared with the standard contrast‐assisted cannulation (CC) technique. Methods: From June 2012 to December 2013, a total of 320 patients who had a naive papilla and were referred for ERCP were randomly assigned to the GWC group (n=160) or the CC group (n=160). GWC or CC was randomly used. In cases of failed cannulation in both arms after crossover, biliary access was attempted with alternative techniques (e.g., dual‐wire technique, pancreatic duct stenting, precut). Results: The biliary cannulation rates were 81% in the GWC group and 73% in the CC group (P=n.s.). Following crossover, cannulation was successful in 8% and 11% of patients in the GWC and CC groups, respectively. With use of an alternative technique, the cannulation rates were 98% in the GWC group and 96% in the CC group, respectively. The rates of PEP were 5% in the GWC group and 12% in the CC group (P=0.027). The post‐interventional complication rates did not differ between the two groups. Conclusion: GWC with the new wire guide is associated with a lower rate of PEP in comparison with the CC technique. Clinical trial reference number: NCT01771419.