P1476 - Clinical Outcomes of Thin 0.025-inch vs Regular 0.035-inch Hydrophilic Guide Wires With Sphincterotome in Wire-Guided Cannulation: A First Meta-Analysis

Faiza Ahmed, MD, MS, BSc¹, Faiza Zakaria, MD², Ammu Susheela, MD³, Alaa Hamdan, MD¹, Ujala Nasr, MD², Anusha Sajja, MD¹, Kim Andrews, MD, PhD, MHA⁴, Sai Harsha Bobba, MD⁵, Shanthi Potla, MD⁶, Aysha Aslam, MD⁷, Marc-Darlene Mezidor, MD⁸, Zeynep Yukselen, MD¹, Raza Zarrar, MD⁹, Karthik Mohan, DO¹, Sarfraz Ahmad, MD, PhD¹⁰, Endrit Shahini, MSc, MD¹¹, Thiruvengadam Muniraj, MD, PhD, MRCP^12
1Larkin Community Hospital, South Miami, FL; ²Dow Medical College, Karachi, Sindh, Pakistan; ³Loyala Medicine/MacNeal Hospital, Berwyn, IL; ⁴Prince Mohammad Bin Fahad University, Al Khobar, Ar Riyad, Saudi Arabia; ⁵Swedish Hospital, Chicago, IL; ⁶Beckley ARH Hospital, Beckley, WV; ⁷Louis A Weiss Memorial Hospital, Chicago, IL; ⁸AMITA Health Saint Joseph Hospital, Evanston, IL; ⁹Mayo Clinic, Rochester, MN; ¹⁰AdventHealth Cancer Institute, Orlando, FL; ¹¹National Institute of Research-Saverio De Bellis, Bari, Basilicata, Italy; ¹²Yale New Haven Health System-Yale Center for Pancreatitis, New Haven, CT

Introduction: Cannulation techniques are recognized to be important in causing post-endoscopic retrograde cholangiopancreatography (ERCP) pancreatitis. For decades, biliary cannulation during ERCP was mostly performed by injecting contrast medium because of hesitation in using guide wire (GW) assisted cannulation technique due to limited accessible data and concerns regarding injury to ampulla, PEP, and other potential GW perforations. Recent comparative studies have reported GWs achieving success rates of 10% and occasionally 90% in comparison with the standard contrast injection method, but clinical differences between thickness of GWs has not been vastly investigated with wire-guided cannulation (WGC). Here, we present the first meta-analysis comparing 0.025-inch and 0.035-inch GWs when used in WGC during ERCP.

Methods: An extensive search using multiple databases was conducted from inception-May 2021. Analysis was done using Excel 2019 and review manager 5.3 Cochrane collaboration, Oxford, UK. Inverse variant was used to weigh the studies and a p value of < 0.05 was considered as statistically significant.

Results: A total of three clinical trials (n=568; male:198, female:135) met our inclusion criteria. Pooled estimate of all studies demonstrated favor to 0.025-inch group in the primary cannulation success rate [1.05,(95%CI;0.87,1.27);p=0.62] and incidence of PEP [1.49(95%CI;0.63,3.52);p=0.36]. Kitamura et al 2015 provided data of patients who developed mild pancreatitis was superior in 0.035 inch group [0.49(95%CI;0.02,11.87); p=0.66], while moderate and severe pancreatitis was higher in 0.025-inch group [(7.32(95%CI, 0.35,150.96;p=0.20) vs.(1.47(95%CI,0.09,23.22);p=0.79]. Pooled analysis of the same study revealed non-significant increase of the final success rate of selective bile duct cannulation [0.95(95%CI;0.90,1.01);p=0.09] and pancreatic duct stent placement rate [0.94 (95%CI,0.53,1.68);p=0.83] favoring the regular GW category. Halttunen et al 2012 and Kitamura et al 2015 trials pooled analysis reported primary cannulation success rate [52 sec, (95%CI,-2.27,3.31); p=0.72], ERCP procedure time [-4.68 min(95%CI,-19.81,10.45);p=0.54], and selective bile duct cannulation time [MD= -0.27(95%CI,-3.24,2.70);p=0.86], all favoring the thin GW group.

Discussion: 0.025-inch and 0.035-inch guide wires both performed satisfactorily when used in wire-guided cannulation (WGC) during ERCP. However, due to paucity of studies, further large randomized clinical trials are warranted to validate these results.


Disclosures:


Faiza Ahmed, MD, MS, BSc¹, Faiza Zakaria, MD², Ammu Susheela, MD³, Alaa Hamdan, MD¹, Ujala Nasr, MD², Anusha Sajja, MD¹, Kim Andrews, MD, PhD, MHA⁴, Sai Harsha Bobba, MD⁵, Shanthi Potla, MD⁶, Aysha Aslam, MD⁷, Marc-Darlene Mezidor, MD⁸, Zeynep Yukselen, MD¹, Raza Zarrar, MD⁹, Karthik Mohan, DO¹, Sarfraz Ahmad, MD, PhD¹⁰, Endrit Shahini, MSc, MD¹¹, Thiruvengadam Muniraj, MD, PhD, MRCP¹². P1476 - Clinical Outcomes of Thin 0.025-inch vs Regular 0.035-inch Hydrophilic Guide Wires With Sphincterotome in Wire-Guided Cannulation: A First Meta-Analysis, ACG 2021 Annual Scientific Meeting Abstracts. Las Vegas, Nevada: American College of Gastroenterology.