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. 2025 Jun 16;6(1):e70144.
doi: 10.1002/deo2.70144. eCollection 2026 Apr.

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

Takeshi Ogura  1 , Yuki Tanisaka  2 , Masanari Sekine  3 , Katsumasa Kobayashi  4 , Hirotsugu Maruyama  5 , Shinji Hirai  6 , Hideyuki Shiomi  7 , Minoru Shigekawa  8 , Masaki Kuwatani  9 , Kenji Ikezawa  10 , Masahiro Itonaga  11 , Mamoru Takenaka  12 , Susumu Hijioka  13 , Tsukasa Ikeura  14 , Shinpei Doi  15 , Nao Fujimori  16 , Kazuya Koizumi  17 , Yousuke Nakai  18 , Tadahisa Inoue  19 , Shuntaro Mukai  20 , Kazuyuki Matsumoto  21 , Ryuki Minami  22 , Koichiro Mandai  23 , Atsuhiro Matsuda  24 , Takuji Iwashita  25 , Hiroki Kawashima  26 , Takao Itoi  20
Affiliations

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

Takeshi Ogura et al. DEN Open. .

Abstract

Objective: 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.

Methods: 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.

Results: 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).

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

Keywords: ERCP; guidewire; pancreatitis; post‐ERCP pancreatitis; wire‐guided cannulation.

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Conflict of interest statement

Takeshi Ogura and Shuntaro Mukai are associated Editors of DEN Open. Takao Itoi is the Editor‐in‐Chief of DEN Open. The other authors declare no conflicts of interest.

Figures

FIGURE 1
FIGURE 1
Kinds of guidewire: A long‐tapered tip (long type, above; J‐WIRE Prologue, J‐MIT Inc., Shiga, Japan) and a short‐tapered tip (short type, below; J‐WIRE Prologue ST, J‐MIT Inc.).
FIGURE 2
FIGURE 2
Biliary cannulation using long‐type guidewire: (a) Biliary cannulation is performed, but the guidewire is looped within the bile duct. (b) Using pushing guidewire, guidewire can be advanced into the biliary tract with a loop shape. (c) The contrast medium is injected. (d) Biliary stenting is performed.
FIGURE 3
FIGURE 3
Pancreatic duct cannulation using long‐type guidewire: (a) Guidewire is inserted into the main pancreatic duct. (b) Using pushing guidewire, a loop shape can be automatically made. (c) Guidewire advancement is successfully performed without duct penetration.
See this image and copyright information in PMC

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