Preventive effects of guidewire-guided selective bile ductal cannulation on pancreatitis and hyperamylasemia after ERCP / 中华肝胆外科杂志

ABSTRACT

Objective To study the preventive effects of selective bile ductal cannulation using an aqua-coat tipped Metro tracer guidewire on pancreatitis and hyperamylasemia after ERCP. Methods A total of 291 patients with biliary disease were enrolled in the study. The patients were randomized into the guidewire group (n= 149) and the control group (n= 142). In the guidewire group, the bile duct was first accessed by insertion of an aqua-coat tipped Metro tracer (diameter 0. 029 inch) guidewire through a 5.5Fdouble channel ERCP-tube to judge the bile duct by the direction of guidewire. As soon as cannulation was accomplished, the guidewire was removed to allow injection of contrast medium and other therapeutic manipulation. In the control group, the bile duct was opacified by the traditional method of cannulation of the biliary tree followed by single ERCP-tube cannulation, judgment of the bile duct by injection of contrast medium and performance of other therapeutic procedures. The incidences of post-ERCP pancreatitis and hyperamylasemia were compared between the 2 groups. Results The selective bile ductal cannulation was successfully conducted in 145 patients in the guidewire group and 138 in the control group. The incidences of post-ERCP pancreatitis and hyperamylasemia were significantly lower in the guidewire group than in the control group. Pancreatitis tended to be less severe for patients in the guidewire group. Conclusion Using the Double-Crossing method in selective bile ductal cannulation with an aqua-coat tipped Metro tracer guidewire reduced not only the frequencies of post-ERCP pancreatitis and hyperamylasemia but also the severity of post-ERCP pancreatitis.