# Japanese Multi‐Institution Study of Success Rates of Wire‐Guided Biliary Cannulation During Endoscopic Retrograde Cholangiopancreatography in Relation to Guidewire tip Length (With Video)

## TL;DR

This study compares long and short tapered guidewire tips for biliary cannulation during endoscopic procedures, finding no significant difference in success rates but fewer pancreatic duct misinsertions with long tips.

## Contribution

The study provides new evidence on the impact of guidewire tip length on biliary cannulation outcomes in endoscopic retrograde cholangiopancreatography.

## Key findings

- No significant difference in technical success rates between long and short tapered guidewire tips.
- Long-tapered guidewires significantly reduced guidewire misinsertion into the main pancreatic duct.
- Adverse event rates, including post-procedure pancreatitis, were not significantly different between groups.

## Abstract

Wire‐guided cannulation (WGC) reportedly increases the successful biliary cannulation rate and reduces the risk of post‐endoscopic retrograde cholangiopancreatography pancreatitis. Currently, various types of guidewires are available. However, the effect of the length of flexible‐tip guidewires on the success rate of biliary cannulation under WGC and the rate of adverse events, especially post‐endoscopic retrograde cholangiopancreatography pancreatitis, is unclear. The aim of this study was to compare the influence of long‐tapered and short‐tapered tips of a 0.025‐inch guidewire on outcomes in primary selective biliary cannulation.

Consecutive patients who underwent biliary access under endoscopic retrograde cholangiopancreatography guidance using WGC at 27 high‐volume centers in Japan were enrolled in this prospective registration study. The primary outcome was the technical success rate of biliary cannulation. The secondary outcomes were the rates of adverse events, biliary cannulation time, and number of guidewire insertions into the pancreatic duct.

A total of 530 patients underwent biliary cannulation for biliary disease with native papilla between April 2021 and December 2023. The technical success rate of biliary cannulation was 86.1% (161/187) in the long‐tip group and 84.3% (289/343) in the short‐tip group, indicating no significant differences between the two groups. Although the frequency of post‐endoscopic retrograde cholangiopancreatography was not significantly different, the successful biliary cannulation rate without guidewire mis‐insertion into the main pancreatic duct was significantly higher in the long tip group (64.7%, 121/187) compared with the short tip group (54.2%, 186/343p = 0.02).

In conclusion, WGC using long‐tip guidewires might reduce the risk of guidewire insertion into the main pancreatic duct.