title: Comparison of standard and steerable catheters for bile duct cannulation in ERCP.
abstract: OBJECTIVE
  The aim of the study was to compare two steerable endoscopic retrograde cholangiopancreatography (ERCP) catheters with regard to speed and safety in cannulating the common bile duct.
  
  
  METHODS
  A standard cannula, a short-nosed sphincterotome, and a bendable catheter were used. At two tertiary centres, a total of 312 patients were randomly assigned to receive treatment with one of three catheters and either by a trainee or an expert endoscopist. When cannulation failed, a further attempt was made with a different catheter. If this failed, a change in operator or other manoeuvres followed. The following were assessed: time to cholangiography and deep cannulation, number of attempts and success rates of cannulation, number of pancreatic duct injections, success of catheter cross-over, and complication rates.
  
  
  RESULTS
  Both steerable catheters were significantly better for the initial cholangiogram than the standard catheter (standard catheter 75 %, bendable catheter 84 %, sphincterotome 88 %; P = 0.038), with no significant differences between the bendable catheter and the sphincterotome. Both were also better for deep cannulation of the bile duct (standard cannula 66 %, bendable catheter 69 %, sphincterotome 78 %; P = 0.15). When the standard catheter failed, a steerable catheter succeeded in 26 % of cases. Trainees experienced greater benefit from using steerable catheters. For experts, the bendable catheter was the quickest to achieve cholangiography and deep cannulation. Further manoeuvres had an 85-90 % success rate in allowing biliary access. Twenty of 23 needle-knife papillotomies (87 %) were successful when other methods had failed. The overall ERCP success rate was 97 %. Pancreatitis occurred in 5.3 % of cases.
  
  
  CONCLUSIONS
  Steerable catheters allow faster access and can succeed when a standard catheter fails. If cannulation is difficult, changing the catheter should be considered at an early stage. Needle-knife papillotomy is a successful technique in expert hands.
authors.affiliation: Academic Dept. of GI-Radiology, South Manchester University Hospitals, Manchester and University of Central Lancashire, Preston, United Kingdom. HUL@smtr.nhs.uk
authors.forename: H-U
authors.initials: HU
authors.lastname: Laasch
authors.forename: A
authors.initials: A
authors.lastname: Tringali
authors.forename: L
authors.initials: L
authors.lastname: Wilbraham
authors.forename: A
authors.initials: A
authors.lastname: Marriott
authors.forename: R E
authors.initials: RE
authors.lastname: England
authors.forename: M
authors.initials: M
authors.lastname: Mutignani
authors.forename: V
authors.initials: V
authors.lastname: Perri
authors.forename: G
authors.initials: G
authors.lastname: Costamagna
authors.forename: D F
authors.initials: DF
authors.lastname: Martin
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001649:Bile Duct Diseases / Q000000981:diagnostic imaging* / Q000601:surgery*; D002404:Catheterization / Q000009:adverse effects*; D002760:Cholangiopancreatography, Endoscopic Retrograde / Q000009:adverse effects*; D004867:Equipment Design; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications; D011446:Prospective Studies; D016717:Sphincterotomy, Endoscopic / Q000009:adverse effects; D013997:Time Factors