实习医生使用普通造影导管进行内镜逆行胰胆管造影时导丝选择（直导丝与弯导丝）：单中心前瞻性随机对照交叉研究
Guide Wire Selection (Straight vs. Angled) in Endoscopic Retrograde Cholangiopancreatography Using a Normal Contrast Catheter Performed by a Trainee: A Single-Center Prospective Randomized Controlled Cross-Over Study.
作者信息
Maki Takumi, Irisawa Atsushi, Yamamiya Akira, Tominaga Keiichi, Abe Yoko, Imbe Koh, Hoshi Koki, Yamabe Akane, Igarashi Ryo, Nakajima Yuki, Sato Kentaro, Shibukawa Goro
机构信息
Department of Gastroenterology, Aizu Medical Center, Fukushima Medical University, 21-2 Kawahigashi Aizuwakamatsu, Fukushima 969-3482, Japan.
Department of Internal Medicine, Minamiaizu Prefectural Hospital, 14-1 Nagata Minamiaizu, Fukushima 967-0006, Japan.
出版信息
J Clin Med. 2023 Apr 17;12(8):2917. doi: 10.3390/jcm12082917.
INTRODUCTION
Wire-guided cannulation (WGC) during endoscopic retrograde cholangiopancreatography (ERCP) is a selective biliary cannulation technique aimed at improving the successful selective biliary cannulation rate and reducing the rate of post-ERCP pancreatitis (PEP) incidence. This study aimed to evaluate the effectiveness of angled-tip guidewires (AGW) vs. straight-tip guidewires (SGW) for biliary cannulation via WGC by a trainee.
METHODS
We conducted a prospective, single-center, open-labeled, randomized, and controlled trial. Fifty-seven patients were enrolled in this study and assigned randomly to two groups (Group A to S and Group S to A). In this study, we started selective biliary cannulation via WGC with an AGW or an SGW for 7 min. If cannulation was unsuccessful, the other guidewire was used, and cannulation was continued for another 7 min (cross-over method).
RESULTS
The selective biliary cannulation success rate over 14 min was significantly higher with an AGW compared with an SGW over 14 min (57.8% vs. 34.3%, = 0.04) and for the second 7-min segment (36.4% vs. 0%, = 0.04). No significant difference was found for adverse events such as pancreatitis between the two guidewires.
CONCLUSIONS
Our results suggest that an AGW is recommended for WGC performed by a trainee.
引言
内镜逆行胰胆管造影术（ERCP）期间的导丝引导插管（WGC）是一种选择性胆管插管技术，旨在提高选择性胆管插管成功率并降低ERCP术后胰腺炎（PEP）的发生率。本研究旨在评估新手通过WGC使用弯头导丝（AGW）与直头导丝（SGW）进行胆管插管的有效性。
方法
我们进行了一项前瞻性、单中心、开放标签、随机对照试验。57例患者纳入本研究并随机分为两组（A至S组和S至A组）。在本研究中，我们通过WGC使用AGW或SGW开始选择性胆管插管7分钟。如果插管不成功，则使用另一根导丝，并继续插管7分钟（交叉法）。
结果
与14分钟内使用SGW相比，14分钟内使用AGW的选择性胆管插管成功率显著更高（57.8%对34.3%，P = 0.04），且在第二个7分钟时间段内也是如此（36.4%对0%，P = 0.04）。两种导丝在胰腺炎等不良事件方面未发现显著差异。
结论
我们的结果表明，推荐新手在WGC中使用AGW。
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