Endoscopy 2003; 35(8): 669-674
DOI: 10.1055/s-2003-41515
Original Article

© Georg Thieme Verlag Stuttgart · New York

Comparison of Standard and Steerable Catheters for Bile Duct Cannulation in ERCP

H.-U.  Laasch 1 , A.  Tringali 2 , L.  Wilbraham 1 , A.  Marriott 1 , R. E.  England 1 , M.  Mutignani 2 , V.  Perri 2 , G.  Costamagna 2 , D. F.  Martin 1
  • 1Academic Dept. of GI-Radiology, South Manchester University Hospitals, Manchester and University of Central Lancashire, Preston, United Kingdom
  • 2Digestive Endoscopy Unit, Catholic University, Rome, Italy
Further Information

Publication History

Submitted 29 July 2002

Accepted after Revision 16 March 2003

Publication Date:
20 August 2003 (online)

Background and Study Aims: The aim of the study was to compare two steerable endoscopic retrograde cholangiopancreatography (ERCP) catheters with regard to speed and safety in cannulating the common bile duct.
Patients and Methods: A standard cannula, a short-nosed sphincterotome, and a bendable catheter were used. At two tertiary centres, a total of 312 patients were randomly assigned to receive treatment with one of three catheters and either by a trainee or an expert endoscopist. When cannulation failed, a further attempt was made with a different catheter. If this failed, a change in operator or other manoeuvres followed. The following were assessed: time to cholangiography and deep cannulation, number of attempts and success rates of cannulation, number of pancreatic duct injections, success of catheter cross-over, and complication rates.
Results: Both steerable catheters were significantly better for the initial cholangiogram than the standard catheter (standard catheter 75 %, bendable catheter 84 %, sphincterotome 88 %; P = 0.038), with no significant differences between the bendable catheter and the sphincterotome. Both were also better for deep cannulation of the bile duct (standard cannula 66 %, bendable catheter 69 %, sphincterotome 78 %; P = 0.15). When the standard catheter failed, a steerable catheter succeeded in 26 % of cases. Trainees experienced greater benefit from using steerable catheters. For experts, the bendable catheter was the quickest to achieve cholangiography and deep cannulation. Further manoeuvres had an 85-90 % success rate in allowing biliary access. Twenty of 23 needle-knife papillotomies (87 %) were successful when other methods had failed. The overall ERCP success rate was 97 %. Pancreatitis occurred in 5.3 % of cases.
Conclusions: Steerable catheters allow faster access and can succeed when a standard catheter fails. If cannulation is difficult, changing the catheter should be considered at an early stage. Needle-knife papillotomy is a successful technique in expert hands.

References

H.-U. Laasch, M.D.

Dept. of Radiology · South Manchester University Hospitals

Southmoor Road, Wythenshawe · Manchester M23 9LT · UK

Fax: +44-161-291-6201

Email: HUL@smtr.nhs.uk