title: Guide wire-a sisted cannulation versus conventional contrast to prevent pancreatitis. A systematic review and meta-analysis based on randomized control trials.
abstract: OBJECTIVE
  Through this systematic review and meta-analysis, we aim to clarify the differences between these two techniques, thus improving primary success cannulation and reducing complications during endoscopic retrograde cholangiopancreatography, primarily pancreatitis.
  
  
  METHODS
  A comprehensive search was conducted to search for data available up until June2015from the most important databases available in the health field: EMBASE, MEDLINE (via PubMed), Cochrane, LILACS and CENTRAL (via BVS), SCOPUS, the CAPES database (Brazil), and gray literature.
  
  
  RESULTS
  Nine randomized clinical trialsincluding2583 people were selected from20,198 studies for meta-analysis. Choledocholithiasis had been diagnosed in mostly (63.8%) of the patients, who were aged an average of 63.15 years. In those patients treated using the guide wire-assisted cannulation technique, provided a significantly lower instance of pancreatitis (RD=0.03; 95% CI: 0.01-0.05; I2= 45%) and greater primary success cannulation (RD=0.07; 95% CI: 0.03-0.12; I2=12%) than conventional contrast cannulation.
  
  
  CONCLUSIONS
  The guide wire-assisted technique, when compared to the conventional contrast technique, reduces the risk of pancreatitis and increases primary success cannulation rate. Thus, guide wire-assisted cannulation appears to be the most appropriate first-line cannulation technique.
authors.affiliation: Gastrointestinal Endoscopy Unit, University of São Paulo. São Paulo, Brazil.
authors.forename: Eduardo T
authors.initials: ET
authors.lastname: de Moura
authors.affiliation: Gastrointestinal Endoscopy Unit, University of São Paulo. São Paulo, Brazil.
authors.forename: Eduardo G
authors.initials: EG
authors.lastname: de Moura
authors.affiliation: Gastrointestinal Endoscopy Unit, University of São Paulo. São Paulo, Brazil.
authors.forename: Wanderley
authors.initials: W
authors.lastname: Bernardo
authors.affiliation: Gastrointestinal Endoscopy Unit, University of São Paulo. São Paulo, Brazil.
authors.forename: Spencer
authors.initials: S
authors.lastname: Cheng
authors.affiliation: Gastrointestinal Endoscopy Unit, University of São Paulo. São Paulo, Brazil.
authors.forename: Andre
authors.initials: A
authors.lastname: Kondo
authors.affiliation: Gastrointestinal Endoscopy Unit, University of São Paulo. São Paulo, Brazil.
authors.forename: Diogo T
authors.initials: DT
authors.lastname: de Moura
authors.affiliation: Gastrointestinal Endoscopy Unit, University of São Paulo. São Paulo, Brazil.
authors.forename: Jose
authors.initials: J
authors.lastname: Bravo
authors.affiliation: Gastrointestinal Endoscopy Unit, University of São Paulo. São Paulo, Brazil.
authors.forename: Everson L
authors.initials: EL
authors.lastname: Artifon
mesh_terms: D002404:Catheterization / Q000009:adverse effects / Q000295:instrumentation / Q000379:methods*; D002760:Cholangiopancreatography, Endoscopic Retrograde / Q000009:adverse effects / Q000379:methods*; D003287:Contrast Media; D006801:Humans; D017063:Outcome Assessment, Health Care; D010195:Pancreatitis / Q000209:etiology / Q000517:prevention & control*; D016032:Randomized Controlled Trials as Topic
chemical_list: D003287:Contrast Media