Can Wire-guided Cannulation Reduce the Risk of Post-endoscopic Retrograde Cholangiopancreatography Pancreatitis? AMeta-analysis of Randomized Controlled Trials Can Wire-Guided
Cannulation Reduce the Risk
Li-Ming Shao; Qing-Yu Chen; Miao-Yan Chen; Jian -Ting Cai
Cannulation Reduce the Risk
Li-Ming Shao; Qing-Yu Chen; Miao-Yan Chen; Jian -Ting Cai
Abstract
Background and Aim: The use of wire-guided cannulation (WGC) for prevention of post -endoscopic retrograde cholangiopancreatography (ERCP) pancreatitis (PEP) is controversial. The aim of the present study was to assess the overall effect of WGC for PEP compared with conventional contrast-assisted cannulation by carrying out a meta-analysis of all available randomized controlled trials (RCT).
Methods: Electronic databases, including PubMed, EMBASE, the Cochrane library and the Science Citation Index, were searched to retrieve relevant trials . In addition, meeting abstracts and the reference lists of retrieved articles were reviewed for further relevantstudies. Outcome measures were the incidence of PEP.
Background and Aim: The use of wire-guided cannulation (WGC) for prevention of post -endoscopic retrograde cholangiopancreatography (ERCP) pancreatitis (PEP) is controversial. The aim of the present study was to assess the overall effect of WGC for PEP compared with conventional contrast-assisted cannulation by carrying out a meta-analysis of all available randomized controlled trials (RCT).
Methods: Electronic databases, including PubMed, EMBASE, the Cochrane library and the Science Citation Index, were searched to retrieve relevant trials . In addition, meeting abstracts and the reference lists of retrieved articles were reviewed for further relevantstudies. Outcome measures were the incidence of PEP.
Results: Four RCT, enrolling a total of 1413 patients, were included. The meta-analysis failed to indicate a significant association between the use of WGC and the reduction of PEP (RR 0 .34; 95% CI: 0 .10 1.17; P = 0.09). Subgroup analysis including trials without cross-over design showed a significant benefit with the use of WGC in reducing PEP (RR 0.20; 95% CI: 0.090.40; P P = 0.58).
Conclusions: This meta-analysis showed only a non-significant reduction in the rate of PEP with the use of WGC. Further well-designed RCT are required to confirm the effect of WGC, especially in patients who were easier to cannulate.
Introduction
Acute pancreatitis remains the most common complication of endoscopic retrograde cholangiopancreatography (ERCP). The incidence of post-ERCP pancreatitis (PEP) varies from 1% to 40% partly as a result of the definition of PEP,[1] but figures of 1.3% to 6.7% are typical in large prospective studies. [26] Generally, ways to prevent of PEP can be divided into two categories: pharmacological and mechanical. However, pharmacological prevention has not been proved effective, although rectal non steroidal anti-inflammatory drugs (NSAIDs) were reported to be efficacious in a recent meta-analysis.[7] Furthermore, no pharmacological agents are widely used in routine clinical practice. Pancreatic duct (PD) stent placement and wire-guided cannulation (WGC) are the most two common endoscopic techniques used in reducing PEP.[8] The prophylactic use of PD stent in patients at high risk has become standard of care,[710 ] whereas the use of WGC for PEP has not reached a consensus by endoscopists.[1114 ]
Accessing the bile duct with the aid of a guidewire may limit mechanical trauma to the papilla or pancreatic sphincter and avoid hydrostatic pressure associated with contrast injection, thereby reducing the likelihood of PEP.[12,13] Recently, several randomized controlled trials (RCT) have been conducted to evaluate the effect of WGC in the prevention of PEP.[1214 ] However, these studies have yielded conflicting conclusions. Therefore, we thought it worthwhile to conduct a metaanalysis of all available RCT to assess the overall effect of WGC for PEP.
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Conclusions: This meta-analysis showed only a non-significant reduction in the rate of PEP with the use of WGC. Further well-designed RCT are required to confirm the effect of WGC, especially in patients who were easier to cannulate.
Introduction
Acute pancreatitis remains the most common complication of endoscopic retrograde cholangiopancreatography (ERCP). The incidence of post-ERCP pancreatitis (PEP) varies from 1% to 40% partly as a result of the definition of PEP,[1] but figures of 1.3% to 6.7% are typical in large prospective studies. [26] Generally, ways to prevent of PEP can be divided into two categories: pharmacological and mechanical. However, pharmacological prevention has not been proved effective, although rectal non steroidal anti-inflammatory drugs (NSAIDs) were reported to be efficacious in a recent meta-analysis.[7] Furthermore, no pharmacological agents are widely used in routine clinical practice. Pancreatic duct (PD) stent placement and wire-guided cannulation (WGC) are the most two common endoscopic techniques used in reducing PEP.[8] The prophylactic use of PD stent in patients at high risk has become standard of care,[710 ] whereas the use of WGC for PEP has not reached a consensus by endoscopists.[1114 ]
Accessing the bile duct with the aid of a guidewire may limit mechanical trauma to the papilla or pancreatic sphincter and avoid hydrostatic pressure associated with contrast injection, thereby reducing the likelihood of PEP.[12,13] Recently, several randomized controlled trials (RCT) have been conducted to evaluate the effect of WGC in the prevention of PEP.[1214 ] However, these studies have yielded conflicting conclusions. Therefore, we thought it worthwhile to conduct a metaanalysis of all available RCT to assess the overall effect of WGC for PEP.
DOWNLOAD COMPLETE PDF HERE
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