title: Can a wire-guided cannulation technique increase bile duct cannulation rate and prevent post-ERCP pancreatitis?: A meta-analysis of randomized controlled trials.
abstract: OBJECTIVE
  The most common technique used to achieve primary deep biliary cannulation is the standard contrast-assisted method. To increase the success rate and reduce the risk of complications, a wire-guided cannulation strategy has been proposed. Prospective studies provided conflicting results as to whether the wire-guided cannulation technique increases the cannulation rate and reduces post-endoscopic retrograde cholangiopancreatography (post-ERCP) pancreatitis risk compared with the standard method. The objective of this study was to carry out a meta-analysis of randomized controlled trials (RCTs) that compares primary biliary cannulation and post-ERCP pancreatitis rates with the wire-guided method and the standard cannulation technique.
  
  
  METHODS
  Literature searches of electronic databases and online clinical trial registers up to March 2009 were conducted to identify RCTs comparing primary cannulation and post-ERCP pancreatitis rates with the wire-guided method and the standard cannulation technique. A meta-analysis of these clinical trials was performed.
  
  
  RESULTS
  Five RCTs were included. Overall, the primary cannulation rates reported with the wire-guided cannulation technique and the standard method were 85.3 and 74.9%, respectively. The pooled analysis of all the selected studies comparing the wire-guided cannulation technique with the standard method yielded an odds ratio (OR) of 2.05 (95% confidence interval (CI): 1.27-3.31). The pooled analysis comparing the post-ERCP pancreatitis rates for the wire-guided-cannulation groups with those for the standard-method groups yielded an OR of 0.23 (95% CI: 0.13-0.41).
  
  
  CONCLUSIONS
  This meta-analysis shows that the wire-guided technique increases the primary cannulation rate and reduces the risk of post-ERCP pancreatitis compared with the standard contrast-injection method. Further large, well-performed, randomized controlled studies are needed to confirm these findings.
authors.affiliation: Department of Internal Medicine and Gastroenterology, University of Bologna, Bologna 40138, Italy.
authors.forename: Vincenzo
authors.initials: V
authors.lastname: Cennamo
authors.forename: Lorenzo
authors.initials: L
authors.lastname: Fuccio
authors.forename: Rocco M
authors.initials: RM
authors.lastname: Zagari
authors.forename: Leonardo H
authors.initials: LH
authors.lastname: Eusebi
authors.forename: Liza
authors.initials: L
authors.lastname: Ceroni
authors.forename: Liboria
authors.initials: L
authors.lastname: Laterza
authors.forename: Carlo
authors.initials: C
authors.lastname: Fabbri
authors.forename: Franco
authors.initials: F
authors.lastname: Bazzoli
mesh_terms: D001652:Bile Ducts; D002404:Catheterization / Q000379:methods*; D002760:Cholangiopancreatography, Endoscopic Retrograde / Q000009:adverse effects* / Q000379:methods; D006801:Humans; D010195:Pancreatitis / Q000209:etiology / Q000517:prevention & control*; D016032:Randomized Controlled Trials as Topic