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CC BY-NC-ND 4.0 · Endosc Int Open 2022; 10(07): E990-E997
DOI: 10.1055/a-1834-7101
Original article

Impact of guidewire caliber on ERCP outcomes: Systematic review and meta-analysis comparing 0.025- and 0.035-inch guidewires

Muhammad Aziz‡
1   Division of Gastroenterology and Hepatology, University of Toledo, Toledo, Ohio, United States
,
Amna Iqbal‡
2   Department of Internal Medicine, University of Toledo, Toledo, Ohio, United States
,
Zohaib Ahmed
2   Department of Internal Medicine, University of Toledo, Toledo, Ohio, United States
,
Saad Saleem
3   Department of Internal Medicine, Sunrise Hospital and Medical center, Las Vegas, Nevada, United States
,
Wade Lee-Smith
4   University of Toledo Libraries, University of Toledo, Toledo, Ohio, United States
,
Hemant Goyal
5   The Wright Center for Graduate Medical Education, Scranton, Pennsylvania, United States
,
Faisal Kamal
6   Division of Gastroenterology, University of California San Francisco, San Francisco, California, United States
,
Yaseen Alastal
1   Division of Gastroenterology and Hepatology, University of Toledo, Toledo, Ohio, United States
,
Ali Nawras
1   Division of Gastroenterology and Hepatology, University of Toledo, Toledo, Ohio, United States
,
Douglas G. Adler
7   Center for Advanced Therapeutic Endoscopy (CATE), Porter Adventist Hospital/PEAK Gastroenterology, Denver, Colorado, United States
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Abstract

Background and study aims The impact of guidewire caliber on endoscopic retrograde pancreatography (ERCP) outcomes are not clear. Recent studies have compared two guidewires, 0.035- and 0.025-inch, in randomized controlled trials (RCTs). We performed a systematic review and meta-analysis of available RCTs to assess if different caliber would change the outcomes in ERCP.

Patients and methods A systematic search of PubMed/Medline, Embase, Cochrane, SciELO, Global Index Medicus and Web of Science was undertaken through November 23, 2021 to identify relevant RCTs comparing the two guidewires. Binary variables were compared using random effects model and DerSimonian-Laird approach. For each outcome, risk-ratio (RR), 95 % confidence interval (CI), and P values were generated. P < 0.05 was considered significant.

Results Three RCTs with 1079 patients (556 in the 0.035-inch group and 523 in the 0.025-inch group) were included. The primary biliary cannulation was similar in both groups (RR: 1.02, CI: 0.96–1.08, P = 0.60). The overall rates of PEP were also similar between the two groups (RR: 1.15, CI: 0.73–1.81, P = 0.56). Other outcomes (overall cannulation rate, cholangitis, perforation, bleeding, use of adjunct techniques) were also comparable.

Conclusions The results of our analysis did not demonstrate a clear benefit of using one guidewire over other. The endoscopist should consider using the guidewire based on his technical skills and convenience.

Supplementary material



Publication History

Received: 20 February 2022

Accepted after revision: 25 April 2022

Accepted Manuscript online:
25 April 2022

Article published online:
15 July 2022

© 2022. The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/)

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  • References

  • 1 McCune WS, Shorb PE, Moscovitz H. Endoscopic cannulation of the ampulla of vater: a preliminary report. Ann Surg 1968; 167: 752-756
    Google Scholar
  • 2 Freeman ML, DiSario JA, Nelson DB. et al. Risk factors for post-ERCP pancreatitis: a prospective, multicenter study. Gastrointest Endosc 2001; 54: 425-434
    CrossrefPubMedGoogle Scholar
  • 3 Bourke MJ, Costamagna G, Freeman ML. Biliary cannulation during endoscopic retrograde cholangiopancreatography: core technique and recent innovations. Endoscopy 2009; 41: 612-617
    Article in Thieme ConnectPubMedGoogle Scholar
  • 4 Freeman ML, Nelson DB, Sherman S. et al. Complications of endoscopic biliary sphincterotomy. N Engl J Med 1996; 335: 909-918
    Google Scholar
  • 5 Masci E, Toti G, Mariani A. et al. Complications of diagnostic and therapeutic ERCP: a prospective multicenter study. Am J Gastroenterol 2001; 96: 417-423
    CrossrefPubMedGoogle Scholar
  • 6 Kochar B, Akshintala VS, Afghani E. et al. Incidence, severity, and mortality of post-ERCP pancreatitis: a systematic review by using randomized, controlled trials. Gastrointest Endosc 2015; 81: 143-149.e9
    CrossrefPubMedGoogle Scholar
  • 7 Testoni PA, Mariani A, Aabakken L. et al. Papillary cannulation and sphincterotomy techniques at ERCP: European Society of Gastrointestinal Endoscopy (ESGE) Clinical Guideline. Endoscopy 2016; 48: 657-683
    Google Scholar
  • 8 Tse F, Yuan Y, Moayyedi P. et al. Guidewire-assisted cannulation for the prevention of post-ERCP pancreatitis: a systematic review and meta-analysis. Endoscopy 2013; 45: 605-618
    Article in Thieme ConnectPubMedGoogle Scholar
  • 9 DerSimonian R, Laird N. Meta-analysis in clinical trials revisited. Contemp Clin Trials 2015; 45: 139-145
    Google Scholar
  • 10 Shuster JJ. Cochrane handbook for systematic reviews for interventions. Higgins JPT, Green S. 5.1.0. published 3/2011 Wiley Online Library;
    Google Scholar
  • 11 Guyatt G, Oxman AD, Akl EA. et al. GRADE guidelines: 1. Introduction-GRADE evidence profiles and summary of findings tables. J Clin Epidemiol 2011; 64: 383-394
    Google Scholar
  • 12 Higgins JPT, Altman DG, Gøtzsche PC. et al. The Cochrane Collaboration’s tool for assessing risk of bias in randomised trials. BMJ 2011; 343: d5928
    Google Scholar
  • 13 Bassan MS, Sundaralingam P, Fanning SB. et al. The impact of wire caliber on ERCP outcomes: a multicenter randomized controlled trial of 0.025-inch and 0.035-inch guidewires. Gastrointest Endosc 2018; 87: 1454-1460
    CrossrefPubMedGoogle Scholar
  • 14 Halttunen J, Kylänpää L. A prospective randomized study of thin versus regular-sized guide wire in wire-guided cannulation. Surg Endosc 2013; 27: 1662-1667
    CrossrefPubMedGoogle Scholar
  • 15 Kitamura K, Yamamiya A, Ishii Y. et al. 0.025-inch vs 0.035-inch guide wires for wire-guided cannulation during endoscopic retrograde cholangiopancreatography: A randomized study. World J Gastroenterol 2015; 21: 9182-9188
    CrossrefPubMedGoogle Scholar
  • 16 Cennamo V, Fuccio L, Zagari RM. et al. Can a wire-guided cannulation technique increase bile duct cannulation rate and prevent post-ERCP pancreatitis? A meta-analysis of randomized controlled trials. Am J Gastroenterol 2009; 104: 2343-2350
    CrossrefPubMedGoogle Scholar
  • 17 Kwon CI, Koh DH, Song TJ. et al. Technical reports of endoscopic retrograde cholangiopancreatography guidewires on the basis of physical properties. Clin Endosc 2020; 53: 65-72
    CrossrefPubMedGoogle Scholar