The impact of wire caliber on ERCP outcomes: a multicenter randomized controlled trial of 0.025-inch and 0.035-inch guidewires.Bassan MS, Sundaralingam P, Fanning SB, Lau J, Menon J, Ong E, Rerknimitr R, Seo DW, Teo EK, Wang HP, Reddy DN, Goh KL, Bourke MJ. Gastrointest Endosc. 2018 Jan 6. [Epub ahead of print]

BACKGROUND AND AIMS:Wire-guided biliary cannulation has been demonstrated to improve cannulation rates and reduce post-ERCP pancreatitis (PEP), but the impact of wire caliber has not been studied. This study compares successful cannulation rates and ERCP adverse events using a 0.025-inch and 0.035-inch guidewire.

METHODS:A randomized, single blinded, prospective multi-center trial at 9 high volume tertiary referral centers in the Asia Pacific region was performed. Patients with an intact papilla and conventional anatomy who did not have head of pancreas or ampullary malignancy undergoing ERCP were recruited. ERCP was performed using a standardized cannulation algorithm and patients were randomized to either a 0.025-inch or 0.035-inch guidewire. The primary outcomes of the study were successful wire guided cannulation and incidence of PEP. Overall successful cannulation and ERCP adverse events were also studied.RESULTS:Seven hundred ten patients were enrolled in the study. Primary wire-guided biliary cannulation rate was similar in 0.025-inch and 0.035-inch wire groups (80.7% vs 80.3% P = 0.9). The rate of post ERCP pancreatitis between the 0.025-inch and the 0.035-inch wire groups did not differ significantly (7.8 % vs 9.3%, P=0.5). No differences were noted in secondary outcomes.CONCLUSIONS:Similar rates of successful cannulation and PEP using 0.025-inch or 0.035-inch guidewires were demonstrated.

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