Endoscopy 2019; 51(04): S75
DOI: 10.1055/s-0039-1681390
ESGE Days 2019 oral presentations
Friday, April 5, 2019 17:00 – 18:30: ERCP cannulation 1 Panorama Hall
Georg Thieme Verlag KG Stuttgart · New York

GUIDE-WIRE AND CONTRAST INJECTION CANNULATION (MIXED TECHNIQUE) IS SUPERIOR TO EXCLUSIVE GUIDE-WIRE BILIARY CANNULATION FOR PREVENTION OF POST-ERCP PANCREATITIS (PEP): A DOUBLE-BLIND, CONTROLLED, RANDOMIZED TRIAL

J Pereira Lima
1   Gastroenterology, UFCSPA, Porto Alegre, Brazil
,
ID Arciniegas
2   UFCSPA, Porto Alegre, Brazil
,
I Contin
2   UFCSPA, Porto Alegre, Brazil
,
G Pereira Lima
3   ULBRA, Porto Alegre, Brazil
,
CE Oliveira dos Santos
4   Gastroenterology, Santa Casa, Bagé, Brazil
,
F Onofrio
1   Gastroenterology, UFCSPA, Porto Alegre, Brazil
› Author Affiliations
Further Information

Publication History

Publication Date:
18 March 2019 (online)

Also available at
 

Aims:

PEP is the most common complication of ERCP. In the last few years, some studies have demonstrated that the use of guide-wire cannulation (GW-C) instead of contrast injection reduces the rate of PEP. Thus, the GW-C technique has become gold standard and contrast injection an almost proscribed technique, although the majority of studies favouring the GW-C technique has shown exaggerated rates of PEP in the contrast cannulation group or do not allow cross-over between both techniques. In this study, we intend to compare GW-C with the mixed technique (GW and/or contrast injection at endoscopist's discretion).

Methods:

727 consecutive patients referred to ERCP in our Department were prospectively evaluated. Of these, 588 naive papilla patients[232 (39.5%) were men, 356 (60.5%) women; mean age 60.3yrs, ranging from 18 – 90yrs] entered into the trial and were randomized to receive exclusive guide-wire cannulation (n = 299) or the mixed technique (n = 289) for selective bile duct cannulation.

Results:

Both groups were comparable in respect to sex, age, race (92% were white) and to diagnoses [75% had duct Stones, n = 444; 18% had neoplasia (n = 106) and 38 (7%) had other diagnoses]. There were 24 cases of PEP [15 (5%) in GW-C group and 9 (3.1%) in the mixed technique group, p < 0.01]. Time to reach deep cannulation was also faster in the latter group (75% < 5 min vs. 50.2% < 5 min, p < 0.001). More than 10 minutes until cannulation was observed in 21% vs. 10% (groups GW-C and mixed technique, respectively, p < 0.001) of the ERCPs. Total ERCP time was also shorter in the mixed technique group (12 vs. 10 minutes; p < 0.001).

Conclusions:

Compared to exclusive G-W- assisted biliary cannulation, the mixed technique reduces the risk of post-ERCP pancreatitis and promotes a faster cannulation time and, consequently, reduces the total procedure time.