title: A prospective randomized controlled multicenter trial of duodenoscopes with 5 degrees and 15 degrees backward-oblique angle using wire-guided cannulation: effects on selective cannulation of the common bile duct in endoscopic retrograde cholangiopancreatography.
abstract: BACKGROUND
  In duodenoscopy, during endoscopic retrograde cholangiopancreatography (ERCP), a backward-oblique angle duodenoscope (BOAD) is generally used. In Japan, 15 degrees BOAD are mainly used, but in Western countries, 5 degrees BOAD are mostly used. In bile duct cannulation associated with ERCP, a catheter for contrast imaging is used in Japan, but wire-guided cannulation (WGC) using a papillotome is standard in Western countries. We conducted a randomized controlled multicenter trial to evaluate the contributions of different duodenoscopes using WGC to selective common bile duct cannulation.
  
  
  METHODS
  Subjects comprised 179 consecutive patients who underwent ERCP. Patients were randomized into the 15 degrees BOAD group (15 degrees group, n = 90) or the 5 degrees BOAD group (5 degrees group, n = 89).
  
  
  RESULTS
  The duodenal papilla could not be accessed endoscopically in two cases from each group. Success rates for bile duct cannulation by WGC without bow-up for the 15 degrees and 5 degrees groups were 85.6 and 56.2%, respectively (P < 0.01). Success rates for bile duct cannulation by WGC with bow-up for the 15 degrees and 5 degrees groups were 88.9 and 78.7%, respectively. Total rates of bile duct cannulation for the 15 degrees and 5 degrees groups were 94.4 and 92.1%, respectively. As for accidents, incidences of acute pancreatitis for the 15 degrees and 5 degrees groups were 5.6 and 9.0%, respectively, with no significant difference seen.
  
  
  CONCLUSIONS
  With 15 degrees BOAD, bile duct cannulation was favorable without papillotome bow-up. With 5 degrees BOAD, the success rate of WGC may be improved by adjusting the angle based on papillotome bow-up.
authors.affiliation: Department of Gastroenterology, Hokkaido University Graduate School of Medicine, Kita-ku, Sapporo, Japan. hiropon@med.hokudai.ac.jp
authors.forename: Hiroshi
authors.initials: H
authors.lastname: Kawakami
authors.forename: Hiroyuki
authors.initials: H
authors.lastname: Maguchi
authors.forename: Tsuyoshi
authors.initials: T
authors.lastname: Hayashi
authors.forename: Nobuyuki
authors.initials: N
authors.lastname: Yanagawa
authors.forename: Atsushi
authors.initials: A
authors.lastname: Chiba
authors.forename: Hiroyuki
authors.initials: H
authors.lastname: Hisai
authors.forename: Hisato
authors.initials: H
authors.lastname: Amizuka
mesh_terms: D000328:Adult; D000369:Aged, 80 and over; D002404:Catheterization / Q000379:methods*; D002760:Cholangiopancreatography, Endoscopic Retrograde / Q000009:adverse effects / Q000295:instrumentation / Q000379:methods*; D003135:Common Bile Duct; D020698:Duodenoscopes; D004384:Duodenoscopy / Q000379:methods; D005260:Female; D006801:Humans; D007564:Japan; D008297:Male; D008875:Middle Aged; D010195:Pancreatitis / Q000209:etiology; D011446:Prospective Studies