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

Naoki Sasahira; Hiroshi Kawakami; Hiroyuki Isayama; Rie Uchino; Yousuke Nakai; Yukiko Ito; Saburo Matsubara; Hirotoshi Ishiwatari; Minoru Uebayashi; Hiroshi Yagioka; Osamu Togawa; Nobuo Toda; Naoya Sakamoto; Junji Kato; Kazuhiko Koike

doi:10.1055/s-0034-1391228

Endoscopy, Table of Contents

Endoscopy 2015; 47(05): 421-429
DOI: 10.1055/s-0034-1391228

Original article

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

Naoki Sasahira

¹Department of Gastroenterology, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan

²Department of Gastroenterology, Sempo Tokyo Takanawa Hospital, Tokyo, Japan

,

Hiroshi Kawakami

³Department of Gastroenterology and Hepatology, Hokkaido University Graduate School of Medicine, Sapporo, Japan

,

Hiroyuki Isayama

¹Department of Gastroenterology, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan

,

Rie Uchino

¹Department of Gastroenterology, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan

⁴Department of Gastroenterology, Kanto Central Hospital, Tokyo, Japan

,

Yousuke Nakai

¹Department of Gastroenterology, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan

,

Yukiko Ito

⁵Department of Gastroenterology, Japanese Red Cross Medical Center, Tokyo, Japan

,

Saburo Matsubara

⁶Department of Gastroenterology, Tokyo Metropolitan Police Hospital, Tokyo, Japan

,

Hirotoshi Ishiwatari

⁷Department of Gastroenterology and Metabolism, Sapporo Medical University, Sapporo, Japan

,

Minoru Uebayashi

⁸Department of Gastroenterology, Japanese Red Cross Kitami Hospital, Hokkaido, Japan

,

Hiroshi Yagioka

⁹Department of Gastroenterology, JR Tokyo General Hospital, Tokyo, Japan

,

Osamu Togawa

¹⁰Department of Gastroenterology, Saitama Medical University International Medical Center, Saitama, Japan

,

Nobuo Toda

¹¹Department of Gastroenterology, Mitsui Memorial Hospital, Tokyo, Japan

,

Naoya Sakamoto

³Department of Gastroenterology and Hepatology, Hokkaido University Graduate School of Medicine, Sapporo, Japan

,

Junji Kato

⁷Department of Gastroenterology and Metabolism, Sapporo Medical University, Sapporo, Japan

,

Kazuhiko Koike

¹Department of Gastroenterology, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan

› Author Affiliations

Abstract

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.

Full Text

References

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Supplementary material