5F sphincterotomes and 4F sphincterotomes are equivalent for the selective cannulation of the common bile duct

Neena Susan Abraham, Stacey P. Williams, Kara Thompson, Jonathon R. Love, Donald G. MacIntosh

Research output: Contribution to journalArticle

10 Citations (Scopus)

Abstract

Background: Cannulation of the common bile duct (CBD) is the first step in endoscopic retrograde cholangiopancreatography (ERCP). Cannulation difficulty is a known risk factor for post-ERCP complications and may be minimized by the use of a smaller caliber sphincterotome. Objective: To compare the efficacy of CBD cannulation with a 4 F versus a 5 F sphincterotome. Design: A randomized controlled trial, with concealed allocation and double-blinding. Patients: Adult patients undergoing their first ERCP at a tertiary referral center. Intervention: Patients were randomized to undergo CBD cannulation with either a 4 F or 5 F sphincterotome. Main Outcome Measurements: Successful deep cannulation in <15 attempts was the primary outcome. Secondary outcomes included number of attempts/time to cannulation, incidence of complications within 24 hours, and overall cannulation success (including patients before and after crossover). Analysis was intention to treat and included standard descriptive and inferential methods. Results: A total of 107 patients were randomized: 51 (4 F) versus 56 (5 F). The majority were female (71%) and white (92%). Baseline demographics, presenting symptoms, and laboratory values were similar between groups. Similar success in initial cannulation was observed: 84.3% (4 F) and 83.9% (5 F). No differences were noted in time to cannulation (5.12 min [SD, 4.8] for 4 F vs 4.46 min [SD, 4.13] for 5 F; p = NS), number of attempts to cannulation (6.2 [SD, 5.2] for 4 F vs 5.7 [SD, 4.9] for 5 F; p = NS), or complications. The overall cannulation success was 92.2% (4 F) and 92.9% (5 F). Limitations: Premature termination of the trial resulted in decreased power. Conclusions: There exists no significant difference in efficacy between 4 F and 5 F sphincterotomes. The choice of initial sphincterotome should be dictated by physician preference.

Original languageEnglish (US)
Pages (from-to)615-621
Number of pages7
JournalGastrointestinal Endoscopy
Volume63
Issue number4
DOIs
StatePublished - Apr 2006
Externally publishedYes

Fingerprint

Common Bile Duct
Catheterization
Endoscopic Retrograde Cholangiopancreatography
Intention to Treat Analysis
Tertiary Care Centers
Randomized Controlled Trials
Demography
Physicians

ASJC Scopus subject areas

  • Gastroenterology

Cite this

5F sphincterotomes and 4F sphincterotomes are equivalent for the selective cannulation of the common bile duct. / Abraham, Neena Susan; Williams, Stacey P.; Thompson, Kara; Love, Jonathon R.; MacIntosh, Donald G.

In: Gastrointestinal Endoscopy, Vol. 63, No. 4, 04.2006, p. 615-621.

Research output: Contribution to journalArticle

Abraham, Neena Susan ; Williams, Stacey P. ; Thompson, Kara ; Love, Jonathon R. ; MacIntosh, Donald G. / 5F sphincterotomes and 4F sphincterotomes are equivalent for the selective cannulation of the common bile duct. In: Gastrointestinal Endoscopy. 2006 ; Vol. 63, No. 4. pp. 615-621.
@article{99be851d899043a2a55fa597ba7779d7,
title = "5F sphincterotomes and 4F sphincterotomes are equivalent for the selective cannulation of the common bile duct",
abstract = "Background: Cannulation of the common bile duct (CBD) is the first step in endoscopic retrograde cholangiopancreatography (ERCP). Cannulation difficulty is a known risk factor for post-ERCP complications and may be minimized by the use of a smaller caliber sphincterotome. Objective: To compare the efficacy of CBD cannulation with a 4 F versus a 5 F sphincterotome. Design: A randomized controlled trial, with concealed allocation and double-blinding. Patients: Adult patients undergoing their first ERCP at a tertiary referral center. Intervention: Patients were randomized to undergo CBD cannulation with either a 4 F or 5 F sphincterotome. Main Outcome Measurements: Successful deep cannulation in <15 attempts was the primary outcome. Secondary outcomes included number of attempts/time to cannulation, incidence of complications within 24 hours, and overall cannulation success (including patients before and after crossover). Analysis was intention to treat and included standard descriptive and inferential methods. Results: A total of 107 patients were randomized: 51 (4 F) versus 56 (5 F). The majority were female (71{\%}) and white (92{\%}). Baseline demographics, presenting symptoms, and laboratory values were similar between groups. Similar success in initial cannulation was observed: 84.3{\%} (4 F) and 83.9{\%} (5 F). No differences were noted in time to cannulation (5.12 min [SD, 4.8] for 4 F vs 4.46 min [SD, 4.13] for 5 F; p = NS), number of attempts to cannulation (6.2 [SD, 5.2] for 4 F vs 5.7 [SD, 4.9] for 5 F; p = NS), or complications. The overall cannulation success was 92.2{\%} (4 F) and 92.9{\%} (5 F). Limitations: Premature termination of the trial resulted in decreased power. Conclusions: There exists no significant difference in efficacy between 4 F and 5 F sphincterotomes. The choice of initial sphincterotome should be dictated by physician preference.",
author = "Abraham, {Neena Susan} and Williams, {Stacey P.} and Kara Thompson and Love, {Jonathon R.} and MacIntosh, {Donald G.}",
year = "2006",
month = "4",
doi = "10.1016/j.gie.2005.10.041",
language = "English (US)",
volume = "63",
pages = "615--621",
journal = "Gastrointestinal Endoscopy",
issn = "0016-5107",
publisher = "Mosby Inc.",
number = "4",

}

TY - JOUR

T1 - 5F sphincterotomes and 4F sphincterotomes are equivalent for the selective cannulation of the common bile duct

AU - Abraham, Neena Susan

AU - Williams, Stacey P.

AU - Thompson, Kara

AU - Love, Jonathon R.

AU - MacIntosh, Donald G.

PY - 2006/4

Y1 - 2006/4

N2 - Background: Cannulation of the common bile duct (CBD) is the first step in endoscopic retrograde cholangiopancreatography (ERCP). Cannulation difficulty is a known risk factor for post-ERCP complications and may be minimized by the use of a smaller caliber sphincterotome. Objective: To compare the efficacy of CBD cannulation with a 4 F versus a 5 F sphincterotome. Design: A randomized controlled trial, with concealed allocation and double-blinding. Patients: Adult patients undergoing their first ERCP at a tertiary referral center. Intervention: Patients were randomized to undergo CBD cannulation with either a 4 F or 5 F sphincterotome. Main Outcome Measurements: Successful deep cannulation in <15 attempts was the primary outcome. Secondary outcomes included number of attempts/time to cannulation, incidence of complications within 24 hours, and overall cannulation success (including patients before and after crossover). Analysis was intention to treat and included standard descriptive and inferential methods. Results: A total of 107 patients were randomized: 51 (4 F) versus 56 (5 F). The majority were female (71%) and white (92%). Baseline demographics, presenting symptoms, and laboratory values were similar between groups. Similar success in initial cannulation was observed: 84.3% (4 F) and 83.9% (5 F). No differences were noted in time to cannulation (5.12 min [SD, 4.8] for 4 F vs 4.46 min [SD, 4.13] for 5 F; p = NS), number of attempts to cannulation (6.2 [SD, 5.2] for 4 F vs 5.7 [SD, 4.9] for 5 F; p = NS), or complications. The overall cannulation success was 92.2% (4 F) and 92.9% (5 F). Limitations: Premature termination of the trial resulted in decreased power. Conclusions: There exists no significant difference in efficacy between 4 F and 5 F sphincterotomes. The choice of initial sphincterotome should be dictated by physician preference.

AB - Background: Cannulation of the common bile duct (CBD) is the first step in endoscopic retrograde cholangiopancreatography (ERCP). Cannulation difficulty is a known risk factor for post-ERCP complications and may be minimized by the use of a smaller caliber sphincterotome. Objective: To compare the efficacy of CBD cannulation with a 4 F versus a 5 F sphincterotome. Design: A randomized controlled trial, with concealed allocation and double-blinding. Patients: Adult patients undergoing their first ERCP at a tertiary referral center. Intervention: Patients were randomized to undergo CBD cannulation with either a 4 F or 5 F sphincterotome. Main Outcome Measurements: Successful deep cannulation in <15 attempts was the primary outcome. Secondary outcomes included number of attempts/time to cannulation, incidence of complications within 24 hours, and overall cannulation success (including patients before and after crossover). Analysis was intention to treat and included standard descriptive and inferential methods. Results: A total of 107 patients were randomized: 51 (4 F) versus 56 (5 F). The majority were female (71%) and white (92%). Baseline demographics, presenting symptoms, and laboratory values were similar between groups. Similar success in initial cannulation was observed: 84.3% (4 F) and 83.9% (5 F). No differences were noted in time to cannulation (5.12 min [SD, 4.8] for 4 F vs 4.46 min [SD, 4.13] for 5 F; p = NS), number of attempts to cannulation (6.2 [SD, 5.2] for 4 F vs 5.7 [SD, 4.9] for 5 F; p = NS), or complications. The overall cannulation success was 92.2% (4 F) and 92.9% (5 F). Limitations: Premature termination of the trial resulted in decreased power. Conclusions: There exists no significant difference in efficacy between 4 F and 5 F sphincterotomes. The choice of initial sphincterotome should be dictated by physician preference.

UR - http://www.scopus.com/inward/record.url?scp=33645232714&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=33645232714&partnerID=8YFLogxK

U2 - 10.1016/j.gie.2005.10.041

DO - 10.1016/j.gie.2005.10.041

M3 - Article

C2 - 16564862

AN - SCOPUS:33645232714

VL - 63

SP - 615

EP - 621

JO - Gastrointestinal Endoscopy

JF - Gastrointestinal Endoscopy

SN - 0016-5107

IS - 4

ER -