Biliary cannulation with contrast and guide-wire (hybrid technique) versus exclusive guide-wire: A prospective randomized, double-blind, comparative trial

Abstract Background and aims The use of exclusive guide-wire cannulation (e-GW) instead of contrast injection reduces post-ERCP pancreatitis (PEP) and pre-cutting and increases cannulation rate. Herein, we intend to compare e-GW with the hybrid technique (GW-C and/or contrast injection). Methods Prospective single-center randomized study, which included all adult patients referred to ERCP from February 2018 to February 2019. Patients with non-naive papilla; previous ERCP; direct infundibulotomy, ampullectomy, Billroth II gastrectomy or pancreatic sphincterotomy; and patients lost to follow up were excluded. Results 727 consecutive patients were assessed. Of these, 588 naive papilla patients were included and randomized to receive e-GW (n = 299) or GW-C (n = 289) for selective biliary cannulation. The mean age was 60.3 years and 60.5% were women. PEP occurred in 15 (5%) cases in e-GW group and 9 (3.1%) in the GW-C group (p = 0.29). Time to reach deep cannulation was faster in the latter group (75%  10 min until cannulation was observed in 21% vs. 10% of the ERCPs (groups e-GW and GW-C, respectively, p  Conclusions Compared to exclusive G-W- assisted biliary cannulation, the hybrid technique promotes faster cannulation and, consequently, reduces the total procedure time and the use of pre-cut techniques, however PEP was not significantly reduced.