Double-guidewire technique for difficult bile duct cannulation: a multicenter randomized, controlled trial - 23/08/11
UDOGUIA-04 Group
Reprint requests: Alberto Herreros de Tejada, MD, PhD, Department of Gastroenterology, Puerta de Hierro Hospital, Autónoma University, Joaquín Rodrigo 2, 28222 Majadahonda Madrid, Spain.Madrid, Oviedo, Valencia, León, Alcorcón, Pamplona, Spain
Abstract |
Background |
ERCP can be associated with serious complications. Difficulty in common bile duct (CBD) cannulation is one of the main risk factors for post-ERCP pancreatitis. The double-guidewire technique (DGT) has been considered a promising alternative approach in difficult cannulation situations.
Objective |
To compare the performance of DGT with the standard cannulation technique (SCT) in patients in whom CBD cannulation is difficult to perform.
Design |
Multicenter randomized, controlled trial.
Setting |
Six tertiary referral centers.
Patients |
A total of 188 patients with difficult CBD cannulation defined by completion of 5 unsuccessful cannulation attempts were enrolled.
Interventions |
Ninety-seven patients were assigned to the DGT group and 91 to the SCT group. Both techniques were compared for an extra 10 cannulation attempts.
Main Outcome Measurements |
CBD cannulation rate, number of attempts required to cannulate, and ERCP-related complications.
Results |
Successful CBD cannulation was achieved in 46 of 97 (47%) patients in the DGT group compared with 51 of 91 (56%) in the SCT group (OR 0.85; 95% CI, 0.64-1.12). The median number of attempts required for each group was 9 and 7, respectively (P = .128). The incidence of post-ERCP pancreatitis was 17% in the DGT group and 8% in the SCT group (OR 2.13; 95% CI, 0.89-5.05).
Limitations |
Reduced number of enrolled subjects and a lack of detailed information regarding the number and extent of pancreatic duct contrast injections.
Conclusions |
In patients with difficult CBD cannulation, DGT was not superior to SCT in achieving CBD cannulation. DGT might be associated with a higher risk of post-ERCP pancreatitis. (This study has been registered in ClinicalTrials.gov with identifier NCT00270868.)
Le texte complet de cet article est disponible en PDF.Abbreviations : CBD, DGT, PD, SCT
Plan
| DISCLOSURE: The following authors received study support by grant FIS 04/1942 from the Fondo de Investigación Sanitaria (Instituto de Salud Carlos III, Spain) and partial funding for shipping costs from Boston Scientific Spain: A. Herreros de Tejada, J. L. Calleja, G. Díaz, V. Pertejo, J. Espinel, G. Cacho, J. Jiménez, I. Millán, F. García, L. Abreu. |
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| See CME section; p. 748. |
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| If you would like to chat with an author of this article, you may contact him at albertoherreros@yahoo.com. |
Vol 70 - N° 4
P. 700-709 - octobre 2009 Retour au numéro
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