Effectiveness of the J-Tip Guidewire for Selective Biliary Cannulation Compared to Conventional Guidewires (The JANGLE Study)

Tsuchiya, Takayoshi; Itoi, Takao; Maetani, Iruru; Shigoka, Hiroaki; Ikeuchi, Nobuhito; Umeda, Junko; Sofuni, Atsushi; Itokawa, Fumihide; Ishii, Kentaro; Kurihara, Toshio; Tsuji, Shujiro; Tanaka, Reina; Tonozuka, Ryosuke; Honjyo, Mitsuyoshi; Mukai, Shuntaro

doi:10.1007/s10620-015-3658-0

Cited by 20 publications

(14 citation statements)

References 31 publications

(60 reference statements)

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“…No difference in the biliary cannulation success rate or PEP incidence was found when 0.035-inch straight and angled-tipped guidewires were compared; the cannulation time was significantly shorter with the angled guidewire [34]. A recent RCT [35] compared angled and J-tipped guidewires, but the success rates for cannulation and the PEP incidence were similar. Hydrophilic-tipped guidewires are commonly used for biliary cannulation because of the reduced friction and good pushability.…”

Section: Does Success Of Biliary Cannulation Depend On the Type Of Gumentioning

confidence: 96%

Papillary cannulation and sphincterotomy techniques at ERCP: European Society of Gastrointestinal Endoscopy (ESGE) Clinical Guideline

et al. 2016

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Guideline 657Testoni Pier Alberto et al. Papillary cannulation and sphincterotomy techniques at ERCP… Endoscopy 2016; 48: 657-683 This Guideline is an official statement of the European Society of Gastrointestinal Endoscopy (ESGE). It provides practical advice on how to achieve successful cannulation and sphincterotomy at minimum risk to the patient. The Grading of Recommendations Assessment, Development, and Evaluation (GRADE) system was adopted to define the strength of recommendations and the quality of evidence. Main recommendations1 ESGE suggests that difficult biliary cannulation is defined by the presence of one or more of the following: more than 5 contacts with the papilla whilst attempting to cannulate; more than 5 minutes spent attempting to cannulate following visualization of the papilla; more than one unintended pancreatic duct cannulation or opacification (low quality evidence, weak recommendation). 2 ESGE recommends the guidewire-assisted technique for primary biliary cannulation, since it reduces the risk of post-ERCP pancreatitis (moderate quality evidence, strong recommendation). 3 ESGE recommends using pancreatic guidewire (PGW)-assisted biliary cannulation in patients where biliary cannulation is difficult and repeated unintentional access to the main pancreatic duct occurs (moderate quality evidence, strong recommendation). ESGE recommends attempting prophylactic pancreatic stenting in all patients with PGW-assisted attempts at biliary cannulation (moderate quality evidence, strong recommendation). 4 ESGE recommends needle-knife fistulotomy as the preferred technique for precutting (moderate quality evidence, strong recommendation). ESGE suggests that precutting should be used only by endoscopists who achieve selective biliary cannulation in more than 80 % of cases using standard cannulation techniques (low quality evidence, weak recommendation). When access to the pancreatic duct is easy to obtain, ESGE suggests placement of a pancreatic stent prior to precutting (moderate quality evidence, weak recommendation).5 ESGE recommends that in patients with a small papilla that is difficult to cannulate, transpancreatic biliary sphincterotomy should be considered if unintentional insertion of a guidewire into the pancreatic duct occurs (moderate quality evidence, strong recommendation). In patients who have had transpancreatic sphincterotomy, ESGE suggests prophylactic pancreatic stenting (moderate quality evidence, strong recommendation). 6 ESGE recommends that mixed current is used for sphincterotomy rather than pure cut current alone, as there is a decreased risk of mild bleeding with the former (moderate quality evidence, strong recommendation). 7 ESGE suggests endoscopic papillary balloon dilation (EPBD) as an alternative to endoscopic sphincterotomy (EST) for extracting CBD stones < 8 mm in patients without anatomical or clinical contraindications, especially in the presence of coagulopathy or altered anatomy (moderate quality evidence, strong recommendation). 8 ESGE does not recommend r...

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Section: Does Success Of Biliary Cannulation Depend On the Type Of Gumentioning

confidence: 96%

Papillary cannulation and sphincterotomy techniques at ERCP: European Society of Gastrointestinal Endoscopy (ESGE) Clinical Guideline

et al. 2016

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“…In recent years, J-tipped GWs to be used for luminal passage and stricture penetration have been developed and reported to be beneficial in selective biliary cannulation. Although the J-shaped tip is considered to be more suitable for pancreatic intervention owing to the low risks of damaging the pancreatic duct and wrong insertion into a branch duct, the utility and safety of J-shaped tip GW in pancreatic intervention had not previously been examined [12]. Here, the initial procedure success rate with the small J-tipped GW was significantly higher than that with the angle-tipped GW.…”

Section: Discussionmentioning

confidence: 94%

“…Recently, J-tipped GW designed for improving luminal passage has been developed and reported to be beneficial in selective biliary cannulations [12, 13]. Although J-tipped GW was not applicable to pancreatic duct endoscopic intervention due to its large tip radius, the newly developed small J-tipped GW with a smaller loop has enabled pancreatic interventions.…”

Section: Introductionmentioning

confidence: 99%

Safety and Efficacy of a Small J-Tipped Guidewire for Pancreatic Duct Endoscopic Intervention

Hirose

Fukasawa

Takano

et al. 2019

Canadian Journal of Gastroenterology and Hepatology

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Background and Aims. The insertion of the guidewires (GWs) into the pancreatic duct is technically difficult, and there is a risk of post-ERCP pancreatitis (PEP). The aim of this study was to evaluate the safety and efficacy of a small J-tipped guidewire for pancreatic duct endoscopic intervention. Methods. This single-site retrospective study was conducted to assess the procedural success rate and adverse events of endoscopic transpapillary interventions to the pancreatic duct in 114 cases using the small J-tipped GW and 180 cases using the angle-tipped GW. Results. The procedural success rate was significantly higher in the small J-tipped GW group compared with that in the angle-tipped GW group (76% versus 47%, P < 0.001). The procedural success-related factors were chronic pancreatitis (OR 0.43, 95% CI 0.22–0.82, P = 0.01), flexion angle of the pancreatic duct < 90° (OR 0.50, 95% CI 0.30–0.80, P = 0.01), and use of the small J-tipped GW (OR 4.63, 95% CI 2.61–8.20, P < 0.001). The rates of total post-ERCP pancreatitis were significantly lower in the small J-tipped GW group compared with that in the angle-tipped GW group (3.5% versus 12.2%, P = 0.01). Multivariate analysis of pancreatitis risk factors indicated that only the use of the small J-tipped GW was a factor in decreasing the risk of developing pancreatitis (OR 0.12, 95% CI 0.09–0.85, P = 0.02). Conclusions. Small J-tipped GWs increase the success rate of the pancreatic duct endoscopic intervention as well as a reduced risk of developing postoperative pancreatitis.

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“…Various procedural techniques intended to minimize the risk for the development of PEP have been assessed, but only GWC and prophylactic PD stenting have proved somewhat effective 10 . Omuta et al found that a J-shaped guidewire facilitated selective biliary cannulation 11 , but Tsuchiya et al demonstrated, in a prospective multicenter controlled study, that the J-tip guidewire was not significantly different from other guidewires in regard to rates of CBD cannulation 12 . Most published studies comparing the effectiveness of GWC and CC have shown divergent results for the two techniques in both preventing PEP and increasing the biliary cannulation rate 13 .…”

Section: Discussionmentioning

confidence: 99%

“…Most nonrandomized and randomized studies have compared the effectiveness of guidewire-assisted cannulation (GWC) with that of contrast-assisted cannulation (CC) for the prevention of PEP but are restricted to low risk patients, and the results so far are conflicting 9 10 11 12 13 14 15 16 17 18 .…”

Section: Introductionmentioning

confidence: 99%

Comparison between loop-tip guidewire-assisted and conventional endoscopic cannulation in high risk patients

et al. 2015

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Background: The guidewire biliary cannulation (GWC) technique may increase the cannulation rate and decrease the risk for post-endoscopic retrograde cholangiopancreatography (ERCP) pancreatitis. The aim of our multicenter prospective randomized controlled trial was to determine if the use of an atraumatic loop-tip guidewire reduces the rate of post-ERCP pancreatitis (PEP) compared with the standard contrast-assisted cannulation (CC) technique. Methods: From June 2012 to December 2013, a total of 320 patients who had a naïve papilla and were referred for ERCP were randomly assigned to the GWC group (n = 160) or the CC group (n = 160). GWC or CC was randomly used. In cases of failed cannulation in both arms after crossover, biliary access was attempted with alternative techniques (e. g., dual-wire technique, pancreatic duct stenting, precut). Results: The biliary cannulation rates were 81 % in the GWC group and 73 % in the CC group (P = n. s.). Following crossover, cannulation was successful in 8 % and 11 % of patients in the GWC and CC groups, respectively. With use of an alternative technique, the cannulation rates were 98 % in the GWC group and 96 % in the CC group, respectively. The rates of PEP were 5 % in the GWC group and 12 % in the CC group (P = 0.027). The post-interventional complication rates did not differ between the two groups. Conclusion: GWC with the new wire guide is associated with a lower rate of PEP in comparison with the CC technique.Clinical trial reference number: NCT01771419

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Effectiveness of the J-Tip Guidewire for Selective Biliary Cannulation Compared to Conventional Guidewires (The JANGLE Study)

Abstract: The biliary cannulation rate of the J-tip guidewire was not significantly different from those of standard guidewires.

Cited by 20 publications

References 31 publications

Papillary cannulation and sphincterotomy techniques at ERCP: European Society of Gastrointestinal Endoscopy (ESGE) Clinical Guideline

Papillary cannulation and sphincterotomy techniques at ERCP: European Society of Gastrointestinal Endoscopy (ESGE) Clinical Guideline

Safety and Efficacy of a Small J-Tipped Guidewire for Pancreatic Duct Endoscopic Intervention

Comparison between loop-tip guidewire-assisted and conventional endoscopic cannulation in high risk patients

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