Impact of guidewire caliber on ERCP outcomes: Systematic review and meta-analysis comparing 0.025- and 0.035-inch guidewires

Abstract

Introduction The impact of guidewire caliber on ERCP outcomes are not clear. Recent studies have compared two guidewires, 0.035” and 0.025” in randomized controlled trials (RCTs). We performed a systematic review and meta-analysis of available RCTs to assess if different caliber would change the outcomes in ERCP. Methods A systematic search of PubMed/Medline, Embase, Cochrane, SciELO, Global Index Medicus and Web of Science was undertaken through November 23rd, 2021 to identify relevant RCTs comparing the two guidewires. Binary variables were compared using random effects model and DerSimonian-Laird approach. For each outcome, risk-ratio (RR), 95% confidence interval (CI), and p-values were generated. A p-value <0.05 was considered significant. Results A total of 3 RCTs with 1079 patients (556 in 0.035” group and 523 in 0.025” group) were included. The primary biliary cannulation was similar in both groups (RR: 1.02, CI: 0.96 – 1.08, p = 0.60). The overall rates of PEP were also similar between the two groups (RR: 1.15, CI: 0.73 – 1.81, p = 0.56). Other outcomes (overall cannulation rate, cholangitis, perforation, bleeding, use of adjunct techniques) were also comparable. Conclusion The results of our analysis did not demonstrate a clear benefit of using one guidewire over other. The endoscopist should consider using the guidewire based on his technical skills and convenience.

Efficacy of a Newly Developed Guidewire for Selective Biliary Cannulation: A Multicenter Randomized Controlled Trial

“…In the present study, the curvedtip guidewire showed a higher biliary cannulation rate than the straight-tip guidewire, and this result showed a similar trend regardless of the guidewire type (NGW or CGW). One study using the curved-tip type showed a tendency toward a higher cannulation rate with the 0.025-inch guidewire (0.035-inch vs. 0.025-inch: 86% vs. 96%, respectively), while other studies using the straight-tip type reported higher cannulation rates with the 0.035-inch guidewire (0.035-inch vs. 0.025-inch: 82% vs. 80.6%, respectively) [6,8]. The ampulla has a papillary fold between the common bile and pancreatic ducts [24].…”

“…Although a 0.035-inch guidewire was more frequently used because of its stiffness, recently, a highperformance 0.025-inch hydrophilic-coated guidewire has been developed and widely used [5,6]. In a recent meta-analysis of biliary cannulation according to the guidewire caliber [8], the primary biliary cannulation rates for the 0.035-and 0.025-inch guidewires were 82.0% and 80.6% (relative ratio, 1.02) and the PEP rates were 6.6% and 6.2% (relative ratio, 1.15), respectively. One study that was not included in the meta-analysis showed a similar biliary cannulation rate; however, the 0.025-inch guidewire had a lower frequency of ampulla contact and shorter cannulation time compared to those with the 0.035-inch guidewire [6].…”

“…Recently, a high-performance 0.025-inch hydrophilic-coated guidewire with a nitinol core similar to 0.035 inch and a flexibility of 0.025 inch has been developed and widely used [5,6]. The 0.025-inch guidewire did not show a better performance status than the 0.035-inch guidewire in selective biliary cannulation [7,8]. However, a previous study showed that the 0.025-inch guidewire had a shorter cannulation time and less contact with the ampulla [6].…”