Prevention of post-endoscopic retrograde cholangiopancreatography pancreatitis by pancreatic duct stenting using a loop-tipped guidewire

Sakai, Yuji; Tsuyuguchi, Toshio; Sugiyama, Harutoshi; Hayashi, Masahiro; Senoo, Junichi; Sasaki, Reina; Kusakabe, Yuko; Nakamura, Masato; Yasui, Shin; Mikata, Rintaro; Miyazaki, Masaru; Yokosuka, Osamu

doi:10.12998/wjcc.v4.i8.213

Cited by 4 publications

(6 citation statements)

References 17 publications

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“…In clinical practice, for patients at risk of post-ERCP pancreatitis, the MICHISUJI may be clinically useful, although confirmation in a clinical trial is needed. However, although the loop shape may help prevent duct penetration 10 11 , creation of the loop shape may make guidewire passage through stricture sites more challenging. This function should therefore also be evaluated in an experimental study.…”

Section: Discussionmentioning

confidence: 99%

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Experimental study of loop shape using 0.025-inch ERCP guidewires (with videos)

et al. 2021

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Background and study aims Duct penetration by the guidewire sometimes occurs during endoscopic retrograde cholangiography, which might lead to adverse events such as acute pancreatitis. To prevent duct penetration, making a loop shape with the guidewire might provide a useful technique. The aim of this experimental study was thus to evaluate which types of guidewire can most easily form a loop shape. Methods This experimental study evaluated six guidewires (0.025-inch, angle type): MICHISUJI; VisiGlide 2; Jagwire; Pathcorse; RevoWave-α UltraHard 2; and M-through. Flexibility of the tip, shaft stiffness, and the ability to form a loop were evaluated for each type in an ex vivo model. Deformation behavior was also recorded on video, and factors suitable for making a loop shape in each guidewire were evaluated. Results Flexibility and stiffness of each guidewire differed significantly. During an experimental study regrading deformation behavior before forming a loop shape, maximum load was lower for MICHISUJI (6.8 g) than for other guidewires (Jagwire [11.3 g], M-through [12.9 g], VisiGlide 2 [12.9 g], Revowave [21 g], and Pathcorse [25.4 g]). Mean time required to achieve a loop shape was as follows: MICHISUJI, 6.2 seconds; M-through, 8.7 seconds; VisiGlide 2, 11.0 seconds; and Revowave, 7.1 seconds. Conclusion In conclusion, characteristics of flexibility and stiffness among guidewires were significantly different in the ex-vivo study. In the experimental study regrading deformation behavior until achieving a loop shape, maximum load also differed. To evaluate whether guidewires easily form a loop shape, clinical study is needed.

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Section: Discussionmentioning

confidence: 99%

“…On the other hand, several authors have described the clinical benefits of using a loop-tip guidewire during biliary cannulation 10 11 . Compared with conventional guidewires, the risk of insertion into a pancreatic branch duct is lower with a loop-tip guidewire due to its shape.…”

Section: Introductionmentioning

confidence: 99%

Experimental study of loop shape using 0.025-inch ERCP guidewires (with videos)

et al. 2021

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“…The major problem associated with pancreatic duct endoscopic intervention is postoperative pancreatitis. GW insertion into the pancreatic duct is considered to be a risk factor for pancreatitis and injury of the pancreatic duct caused by the GW may result in serious outcomes [2–6, 11]. Although stent placement in the pancreatic duct is reported to be beneficial for prevention of the incidence of PEP caused by duodenal papilledema [7–10], the preventive effect against PEP in cases with injury of the pancreatic duct has not been confirmed.…”

Section: Discussionmentioning

confidence: 99%

“…Sakai et al have reported on the preventive effect of loop-tipped GWs against PEP [6]. Loop-tipped GWs resulted in less frequent unintended insertion of the guidewire into a side branch of the pancreatic duct than conventional GWs and led to significantly lower serum amylase levels after treatment.…”

Section: Discussionmentioning

confidence: 99%

“…Although pancreatic duct endoscopic intervention is usually performed with guidewire (GW) placed in the pancreatic duct, the insertion of a GW itself is difficult because the pancreatic duct is anatomically more complicated with advanced curves and strictures compared with the biliary duct [1]. In addition, GW insertion into the pancreatic duct is reportedly a risk factor for post-ERCP pancreatitis (PEP), causing papillary edema and injury of the pancreatic duct and parenchyma [2–6].…”

Section: Introductionmentioning

confidence: 99%

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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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Ercp後膵炎ガイドライン2023

2024

Journal of the Japan Pancreas Society

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Prevention of post-endoscopic retrograde cholangiopancreatography pancreatitis by pancreatic duct stenting using a loop-tipped guidewire

Cited by 4 publications

References 17 publications

Experimental study of loop shape using 0.025-inch ERCP guidewires (with videos)

Experimental study of loop shape using 0.025-inch ERCP guidewires (with videos)

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

Ercp後膵炎ガイドライン2023

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