Early use of double-guidewire technique to facilitate selective bile duct cannulation: the multicenter randomized controlled EDUCATION trial

被引：60

作者：

Sasahira, Naoki ^{[1
,2
]}

Kawakami, Hiroshi ^{[3
]}

Isayama, Hiroyuki ^{[1
]}

Uchino, Rie ^{[1
,4
]}

Nakai, Yousuke ^{[1
]}

Ito, Yukiko ^{[5
]}

Matsubara, Saburo ^{[6
]}

Ishiwatari, Hirotoshi ^{[7
]}

Uebayashi, Minoru ^{[8
]}

Yagioka, Hiroshi ^{[9
]}

Togawa, Osamu ^{[10
]}

Toda, Nobuo ^{[11
]}

Sakamoto, Naoya ^{[3
]}

Kato, Junji ^{[7
]}

Koike, Kazuhiko ^{[1
]}

机构：

[1] Univ Tokyo, Grad Sch Med, Dept Gastroenterol, Tokyo 1138655, Japan

[2] Sempo Tokyo Takanawa Hosp, Dept Gastroenterol, Tokyo, Japan

[3] Hokkaido Univ, Dept Gastroenterol & Hepatol, Grad Sch Med, Sapporo, Hokkaido, Japan

[4] Kanto Cent Hosp, Dept Gastroenterol, Tokyo, Japan

[5] Japanese Red Cross Med Ctr, Dept Gastroenterol, Tokyo, Japan

[6] Tokyo Metropolitan Police Hosp, Dept Gastroenterol, Tokyo, Japan

[7] Sapporo Med Univ, Dept Gastroenterol & Metab, Sapporo, Hokkaido, Japan

[8] Japanese Red Cross Kitami Hosp, Dept Gastroenterol, Sapporo, Hokkaido, Japan

[9] JR Tokyo Gen Hosp, Dept Gastroenterol, Tokyo, Japan

[10] Saitama Med Univ, Int Med Ctr, Dept Gastroenterol, Saitama, Japan

[11] Mitsui Mem Hosp, Dept Gastroenterol, Tokyo 101, Japan

来源：

ENDOSCOPY | 2015年 / 47卷 / 05期

关键词：

POST-ERCP PANCREATITIS; ENDOSCOPIC RETROGRADE CHOLANGIOPANCREATOGRAPHY; DIFFICULT BILIARY CANNULATION; PRECUT SPHINCTEROTOMY; DEEP CANNULATION; WIRE PLACEMENT; RISK; METAANALYSIS; COMPLICATIONS; PREVENTION;

D O I：

10.1055/s-0034-1391228

中图分类号：

R57 [消化系及腹部疾病];

学科分类号：

摘要：

Background and study aims: There are no guidelines for the timing of conversion from a single-guidewire to a double-guidewire technique to facilitate selective bile duct cannulation and reduce post-endoscopic retrograde cholangiopancreatography pancreatitis (PEP), when using wire-guided cannulation. We investigated whether early conversion to the double-guidewire method, at first unintentional insertion of a guidewire into the pancreatic duct, facilitated selective bile duct cannulation and reduced PEP compared with repeated single-guidewire attempts. Patients and methods: A multicenter prospective randomized controlled trial included 274 patients with a naive papilla, undergoing endoscopic retrograde cholangiography (ERC) using wire-guided cannulation in whom there was unintentional insertion of the guidewire into the pancreatic duct. With the guidewire still in the duct, patients were randomly assigned to undergo the double-guidewire technique or repeated single-wire cannulation. Main outcomes were success rates for selective bile duct cannulation and PEP frequency. Results: Success rates for selective bile duct cannulation within 10 attempts and 10 minutes were 75% and 70%, respectively, for the early double-guidewire (EDG) and repeated single-guidewire (RSG) cannulation groups (relative rate 1.07, 95% confidence interval [95 %CI] 0.93-1.24, P=0.42). Corresponding final selective bile duct cannulation rates were 98% and 97% (relative rate 1.01, 95% CI 0.97-1.05, P=1.00). PEP rates were 20% and 17%, respectively, for the EDG and RSG cannulation groups (relative risk 1.17, 95% CI 0.71-1.94, P=0.53). Double-guidewire cannulation was more effective in patients with malignant biliary stricture (relative rate 1.36, 95% CI 1.05-1.77, P=0.02). Conclusions: During therapeutic ERC using wire-guided cannulation, converting to a double-guidewire technique neither facilitated selective bile duct cannulation nor decreased PEP incidence compared with repeated use of a single-wire technique.

引用

页码：421 / 429

页数：9

共 34 条

[1] Success rate and cannulation time between precut sphincterotomy and double-guidewire technique in truly difficult biliary cannulation [J].