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IS THE INCIDENCE OF POST-ENDOSCOPIC CHOLANGIOPANCREATOGRAPHY (ERCP) PANCREATITIS REDUCED IN PATIENTS UNDERGOING HYDROPHILIC GUIDEWIRE CANNULATION OF THE COMMON BILE DUCT (CBD) VERSUS STANDARD CANNULATION WITH DYE INJECTION: A RANDOMIZED CONTROLLED TRIAL

S Gruchy, D MacIntosh, D Farina, M Molinari, M Khaliq-Kareemi
Division of Gastroenterology, Dalhousie University, Halifax, Nova Scotia

BACKGROUND: Pancreatitis is the most common complication of ERCP with published rates of 5-8%. Repeated injection of the pancreatic duct with contrast has been reported to increase the risk of post-ERCP pancreatitis. A hydrophilic guidewire may be used for cannulation if attempts at duct cannulation have been unsuccessful. We hypothesized that a priori use of a hydrophilic guidewire to cannulate the CBD may result in a significant decrease in the incidence of post-ERCP pancreatitis when compared to the standard cannulation with dye injection by avoiding unintended contrast injection of the pancreatic duct.
METHODS: Patients about to undergo their first ERCP who had not previously been diagnosed with pancreatitis were consecutively enrolled and randomly assigned to undergo cannulation of the CBD with either a guidewire or dye injection. Serum amylase levels were obtained prior to the ERCP and twenty-four hours post procedure. The primary outcome was the incidence of post-ERCP pancreatitis as defined by standard criteria. Secondary outcomes included the incidence of significant bleeding, success of CBD cannulation and immediate complications. Analyses were performed on an intention to treat basis.
RESULTS: Two hundred and twenty-seven patients were randomized (115 guidewire, 112 dye). Fourteen were lost to follow up. The overall incidence of post-ERCP pancreatitis was 5.9%. There was no significant difference in the incidence of pancreatitis for the two groups (guidewire 5% vs dye 7.7%; p=0.444). There were 2 cases of post-sphincterotomy bleeding in the wire access group and none in the dye group (p=0.241). There was no statistically significant difference in the rate of successful CBD cannulation comparing the two study groups (97% dye, 96% wire; p=0.821).
CONCLUSIONS: Interim analysis of this ongoing trial indicates that there may be no significant reduction in the incidence of post-ERCP pancreatitis using wire cannulation.

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