Prospective randomized pilot trial of selective biliary cannulation using pancreatic guide-wire placement

Background and Study Aims: In difficult cases of selective bile duct cannulation, several expanded techniques are available which have only been partially evaluated in randomized studies. This study describes a prospective, randomized trial investigating a further technique for obtaining selective biliary access pancreatic duct wire placement. Patients and Methods: During a 6-month study period, 107 consecutive patients required deep selective biliary cannulation. Accessing the bile duct using a catheter failed within 40 min in 53 of the patients, who were randomly assigned to either preinsertion of a guide wire into the pancreatic duct or persistence with a conventional catheter. The success rate and complication rate were compared between these two groups. Results: In the pancreatic duct guide-wire group (n=27), the success rate was significantly higher than in the conventional group (93% versus 58%). No pancreatitis complications occurred in either group. Conclusions: Inserting a guide wire into the pancreatic duct to facilitate deep selective bile duct cannulation is better than persisting with a conventional catheter. Further studies will be needed to confirm these results and to compare this method with other sophisticated techniques for obtaining selective access to the biliary duct.