Wire-Guided Cannulation

Abstract

Selective bile duct cannulation (SBDC) is the most common technique for performing diagnostic and therapeutic biliary interventions. Wire-guided cannulation (WGC) is most commonly used in Western countries. A meta-analysis of randomized controlled trials (RCTs) found that WGC facilitates the primary SBDC and decreases the incidence of post-endoscopic retrograde cholangiopancreatography pancreatitis (PEP). However, the RCTs involved one or at most two skilled endoscopists in a single-center setting. In more recent Japanese RCTs that were conducted at multiple centers by multiple endoscopists and using a crossover design, WGC did not improve the success rate of SBDC or the incidence of PEP compared with the conventional technique. We performed a multicenter RCT and found that WGC reduced the time required for SBDC, resulting in lower exposure to fluoroscopy. We conclude that WGC should be adopted for use in SBDC, leading to significantly less exposure to fluoroscopy. With a variety of SBDC techniques available, considerations for choice of technique should include operator, patient, and institutional factors. Endoscopists should be familiar with various techniques to allow flexibility depending upon each case. To improve the safety and efficacy of WGC, training and technique standardization are necessary. Here, we describe the novel use of WGC in SBDC, results of meta-analysis of WGC, results of the recent RCTs from Japan, and future perspectives.