Can wire-guided cannulation prevent post-ERCP pancreatitis? A prospective randomized trial

BackgroundAmong the procedure-related factors associated with post-ERCP pancreatitis, selective cannulation of the common bile duct by insertion of a guidewire may be associated with fewer complications than conventional methods of cannulation with contrast injection to access the bile duct. However, the results of studies regarding the usefulness of wire-guided cannulation (WGC) are conflicting.ObjectiveThis prospective randomized trial was designed to determine whether WGC reduces the rate of post-ERCP pancreatitis.DesignA prospective randomized controlled trial.SettingTertiary-care academic medical center.PatientsA total of 300 consecutive patients with native papilla and pancreaticobiliary disease who were candidates for therapeutic ERCP were randomized from June 2006 to May 2007.InterventionsWGC without contrast injection or conventional cannulation with contrast injection.Main Outcome MeasurementsPost-ERCP pancreatitis, risk factors, and procedure-related complications were evaluated prospectively.ResultsA total of 3 patients (2%) in the WGC group and 17 patients (11.3%) in the conventional group had post-ERCP pancreatitis (P = .001). Among the cases of acute pancreatitis in the WGC group, 2 patients with suspected sphincter of Oddi dysfunction (SOD) and unintentional main pancreatic duct (PD) guidewire cannulation showed post-ERCP pancreatitis despite the use of WGC. In multivariate analysis, WGC was a protective factor (odds ratio 0.1; 95% CI, 0.024-0.490, P = .004), whereas female sex and SOD were risk factors for post-ERCP pancreatitis.LimitationOur study population was a low-risk cohort.ConclusionsWGC is associated with a lower rate of post-ERCP pancreatitis. However, WGC may not prevent post-ERCP pancreatitis in patients with suspected SOD and unintentional PD guidewire cannulation.