title: Wire-guided cannulation versus contrast-guided cannulation in pediatric endoscopic retrograde cholangiopancreatography.
abstract: OBJECTIVE
  Wire-guided cannulation (WGC) of the common bile duct may be associated with fewer complications and higher success rate compared with contrast-guided cannulation (CGC) in adults. Data in children are lacking. The aim of this study was to compare the successful cannulation and complication rate of WGC and CGC in pediatric endoscopic retrograde cholangiopancreatography (ERCP).
  
  
  METHODS
  We report a retrospective cohort study comparing WGC to CGC in a pediatric cohort. We reviewed the medical records of 167 children who underwent ERCP over a 10-year time period (CGC, 1999-2003, WGC, 2003-2009). Indications, findings, and success were analyzed.
  
  
  RESULTS
  A total of 93 patients (56%) underwent WGC and 74 (44%) CGC. Children in the WGC group were younger (9.5 ± 4.7 vs. 11.5 ± 4.6 years in CGC; P = 0.006) and underwent more therapeutic ERCP interventions (70% vs. 40% in CGC), whereas diagnostic ERCP was more common in the CGC group (60%; P < 0.005). The overall success (96%) and complication rate (8%) were identical in both groups but a trend toward a reduction in the complication rate over time was noted in the WGC group. Post-ERCP pancreatitis (PEP) was documented in one patient in the WGC group (1.1%) and three patients (4.2%) in the CGC group (P-NS).
  
  
  CONCLUSIONS
  The success and complication rate in both CGC and WGC are comparable in children but considering the patient and procedure complexity and the trend toward lower PEP in the WGC group, WGC may be the preferable cannulation technique for ERCP in children.
authors: Division of Gastroenterology, Hepatology and Nutrition, Department of Paediatrics, The Hospital for Sick Children, University of Toronto, Canada; Department of Pediatrics and KAIMRC, King Abdulaziz Medical City, Ministry of National Guard, Riyadh, Saudi Arabia, .
authors: Maher Al
authors: MA
authors: Hatlani
authors: Paul
authors: P
authors: Kortan
authors: Gary
authors: G
authors: May
authors: Simon C
authors: SC
authors: Ling
authors: Thomas
authors: T
authors: Walters
authors: Yaron
authors: Y
authors: Avitzur
mesh_terms: D000293:Adolescent; D002404:Catheterization / Q000009:adverse effects / Q000295:instrumentation* / Q000379:methods*; D002648:Child; D002760:Cholangiopancreatography, Endoscopic Retrograde / Q000009:adverse effects / Q000295:instrumentation / Q000379:methods*; D015331:Cohort Studies; D003135:Common Bile Duct / Q000601:surgery*; D003287:Contrast Media; D005260:Female; D006801:Humans; D008297:Male; D010195:Pancreatitis / Q000209:etiology; D012189:Retrospective Studies; D016717:Sphincterotomy, Endoscopic / Q000009:adverse effects / Q000379:methods; D015607:Stents; D016896:Treatment Outcome
chemical_list: D003287:Contrast Media