Comparison of Deep Bile Duct Cannulation with Cannulatome Versus Cannulatome with Guide Wire: A Prospective Randomized Trial

Abstract

Background: During the endoscopic retrograde cholangiopancreatography (ERCP) the main step is the cannulation of major duodenal papilla to obtain deep cannulation of bile duct, and it is correlated to pancreaticobiliary complications being that acute pancreatitis is the most frequent. Aim: compare the rate of success to achieve selective cannulation of common bile duct using a cannulatome and cannulatome with guide-wire; compare the amylase, lypase and C reactive protein serum level between the groups and evaluate the incidence of pancreatitis in the groups. Patients and Methods: From July 2002 to October 2003 341 ERCP were performed at our institution. Three hundred consecutive patients were randomized to duodenal papilla cannulation using cannulatome (Group I) and cannulatome with guide wire (Group II). All the endoscopic procedures were performed by the first author. All patients were hospitalized for 24 hours after ERCP. Amylase , lipase, C-reactive protein were assessed before, 4, 12 and 24 hours after the procedure. CT scan was performed if the patient complained of pain and presented an amylase over three times the normal level. Results: The frequency of cannulations of pancreatic duct were similar in both Groups (p=0,161). Deep biliary cannulation without precut was more frequent in Group II (p=0,023). The precut was applied more frequently in Group I (p=0,01). Group II presented a significant lower incidence of acute pancreatitis (p=0,04). More patients in Group I presented hiperamylasemia at 4, 12 and 24 hours (p=0,0087; p=0,045; p=0,0475, respectively). The number of pancreatic cannulations was related to hiperamylasemia and acute pancreatitis. The acute pancreatitis post ERCP were significantly higher in Group I (p=0,037). Conclusion: The biliary access with cannulotome loaded with guide wire is related to higher success rate of selective biliary cannulation and less pancreatic trauma.