Prospective randomized pilot trial of selective biliary cannulation using pancreatic guide-wire placement.
OBJECTIVE
In difficult cases of selective bile duct cannulation, several expanded techniques are available which have only been partially evaluated in randomized studies. This study describes a prospective, randomized trial investigating a further technique for obtaining selective biliary access--pancreatic duct wire placement.


METHODS
During a six-month study period, 107 consecutive patients required deep selective biliary cannulation. Accessing the bile duct using a catheter failed within 10 min in 53 of the patients, who were randomly assigned to either pre-insertion of a guide wire into the pancreatic duct or persistence with a conventional catheter. The success rate and complication rate were compared between these two groups.


RESULTS
In the pancreatic duct-guide wire group (n=27), the success rate was significantly greater than in the conventional group (93% vs 58%). No pancreatitis complications occurred within either group.


CONCLUSIONS
Inserting a guide wire into the pancreatic duct to facilitate deep selective bile duct cannulation is better than persisting with a conventional catheter. Further studies will be needed to confirm these results and to compare this method with other sophisticated techniques for obtaining selective access to the bile duct.
Maeda
S
S
Department of Surgery, Fukui Prefectural Hospital, Yotsui 2-8-1, Fukui-shi 910-8526, Japan. pxt01173@nifty.ne.jp
Hayashi
H
H
Hosokawa
O
O
Dohden
K
K
Hattori
M
M
Morita
M
M
Kidani
E
E
Ibe
N
N
Tatsumi
S
S
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002404:Catheterization / Q000295:instrumentation*; D002760:Cholangiopancreatography, Endoscopic Retrograde / Q000379:methods*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010183:Pancreatic Ducts / Q000000981:diagnostic imaging*; D010865:Pilot Projects; D011446:Prospective Studies