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A prospective randomized controlled multicenter trial of duodenoscopes with 5° and 15° backward-oblique angle using wire-guided cannulation: effects on selective cannulation of the common bile duct in endoscopic retrograde cholangiopancreatography

  • Original Article—Liver, Pancreas, and Biliary Tract
  • Published:
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Abstract

Background

In duodenoscopy, during endoscopic retrograde cholangiopancreatography (ERCP), a backward-oblique angle duodenoscope (BOAD) is generally used. In Japan, 15° BOAD are mainly used, but in Western countries, 5° BOAD are mostly used. In bile duct cannulation associated with ERCP, a catheter for contrast imaging is used in Japan, but wire-guided cannulation (WGC) using a papillotome is standard in Western countries. We conducted a randomized controlled multicenter trial to evaluate the contributions of different duodenoscopes using WGC to selective common bile duct cannulation.

Methods

Subjects comprised 179 consecutive patients who underwent ERCP. Patients were randomized into the 15° BOAD group (15° group, n = 90) or the 5° BOAD group (5° group, n = 89).

Results

The duodenal papilla could not be accessed endoscopically in two cases from each group. Success rates for bile duct cannulation by WGC without bow-up for the 15° and 5° groups were 85.6 and 56.2%, respectively (P < 0.01). Success rates for bile duct cannulation by WGC with bow-up for the 15° and 5° groups were 88.9 and 78.7%, respectively. Total rates of bile duct cannulation for the 15° and 5° groups were 94.4 and 92.1%, respectively. As for accidents, incidences of acute pancreatitis for the 15° and 5° groups were 5.6 and 9.0%, respectively, with no significant difference seen.

Conclusions

With 15° BOAD, bile duct cannulation was favorable without papillotome bow-up. With 5° BOAD, the success rate of WGC may be improved by adjusting the angle based on papillotome bow-up.

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Abbreviations

ERCP:

Endoscopic retrograde cholangiopancreatography

BOAD:

Backward-oblique angle duodenoscope

WGC:

Wire-guided cannulation

ITT:

Intention-to-treat

PP:

Per protocol

CBD:

Common bile duct

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Acknowledgments

We express our deepest appreciation to the members of the Hokkaido Pancreaticobiliary-Study Group (HPSG) and to their institutions. For full details, please see the Appendix.

Conflict of interest statement

We declare that we have no conflict of interest.

Author information

Authors and Affiliations

  1. Department of Gastroenterology, Hokkaido University Graduate School of Medicine, Kita 15, Nishi 7, Kita-ku, Sapporo, 060-8638, Japan

    Hiroshi Kawakami

  2. Center for Gastroenterology, Teine-Keijinkai Hospital, Sapporo, Japan

    Hiroyuki Maguchi

  3. Department of 4th Internal Medicine, Sapporo Medical University School of Medicine, Sapporo, Japan

    Tsuyoshi Hayashi

  4. Department of Gastroenterology, Asahikawa Kosei Hospital, Asahikawa, Japan

    Nobuyuki Yanagawa

  5. Department of Internal Medicine, Asahikawa City Hospital, Asahikawa, Japan

    Atsushi Chiba

  6. Department of Gastroenterology, Date Red Cross Hospital, Date, Japan

    Hiroyuki Hisai

  7. Department of Gastroenterology, Sapporo Higashi Tokushukai Hospital, Sapporo, Japan

    Hisato Amizuka

Authors
  1. Hiroshi Kawakami
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  2. Hiroyuki Maguchi
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  3. Tsuyoshi Hayashi
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  4. Nobuyuki Yanagawa
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  5. Atsushi Chiba
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  6. Hiroyuki Hisai
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  7. Hisato Amizuka
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Corresponding author

Correspondence to Hiroshi Kawakami.

Additional information

All authors are members of the Hokkaido Pancreaticobiliary-Study Group (HPSG). See Appendix.

Appendix

Appendix

Hokkaido Pancreaticobiliary-Study Group (HPSG) consists of Hiroshi Kawakami. MD, Masaki Kuwatani. MD, Kazunori Etoh. MD, Shin Haba. MD, Manabu Onodera. MD, Hokkaido University Hospital (Department of Gastroenterology), Hiroyuki Maguchi. MD, Kuniyuki Takahashi. MD, Akio Katanuma. MD, Manabu Osanai. MD, Teine-Keijinkai Hospital (Center for Gastroenterology), Tsuyoshi Hayashi. MD, Hirotoshi Ishiwatari. MD, Sapporo Medical University School of Medicine (Department of 4th Internal Medicine), Nobuyuki Yanagawa. MD, Asahikawa Kosei Hospital (Department of Gastroenterology), Atsushi Chiba. MD, Kazuya Koizumi. MD, Asahikawa City Hospital (Department of Internal Medicine), Hiroyuki Hisai. MD, Japan Red Cross Date General Hospital (Department of Gastroenterology), and Hisato Amizuka. MD, Sapporo Higashi Tokushukai Hospital (Department of Gastroenterology).

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Kawakami, H., Maguchi, H., Hayashi, T. et al. A prospective randomized controlled multicenter trial of duodenoscopes with 5° and 15° backward-oblique angle using wire-guided cannulation: effects on selective cannulation of the common bile duct in endoscopic retrograde cholangiopancreatography. J Gastroenterol 44, 1140–1146 (2009). https://doi.org/10.1007/s00535-009-0107-x

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  • DOI: https://doi.org/10.1007/s00535-009-0107-x

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