| Autor: |
Han SY; Department of Internal Medicine, Pusan National University School of Medicine, Biomedical Research Institute, Pusan National University Hospital, Busan 49421, Republic of Korea., Choe JW; Department of Internal Medicine, Korea University Ansan Hospital, Ansan 15355, Republic of Korea., Kim DU; Department of Internal Medicine, Pusan National University School of Medicine, Biomedical Research Institute, Pusan National University Hospital, Busan 49421, Republic of Korea., Hyun JJ; Department of Internal Medicine, Korea University Ansan Hospital, Ansan 15355, Republic of Korea., Han JH; Department of Internal Medicine, Chungbuk National University College of Medicine, Chungbuk National University Hospital, Cheongju 28644, Republic of Korea., So H; Department of Internal Medicine, Ulsan University Hospital, University of Ulsan College of Medicine, Ulsan 05505, Republic of Korea., Bang SJ; Department of Internal Medicine, Ulsan University Hospital, University of Ulsan College of Medicine, Ulsan 05505, Republic of Korea., Koh DH; Department of Internal Medicine, Hallym University Dongtan Sacred Heart Hospital, Hwasung 18450, Republic of Korea., Jeong S; Department of Internal Medicine, Inha University Hospital, Inha University School of Medicine, Incheon 22212, Republic of Korea. |
| Abstrakt: |
Background: There is insufficient information regarding the optimal guidewire for managing malignant hilar biliary obstruction (MHBO). Therefore, a newly designed 0.025-inch guidewire was compared with the conventional 0.035-inch guidewire for selective cannulation of both intrahepatic ducts (IHDs) in patients with MHBO. Methods: Patients were randomly enrolled into the curved type newly designed 0.025-inch guidewire group (0.025 group) or the curved type conventional 0.035-inch guidewire group (0.035 group). The primary outcome was the selective cannulation rate of IHD. If the assigned guidewire failed to pass the stricture within 5 min, the crossover guidewire was selected. If the crossover guidewire failed to cross the stricture within the next 5 min, it was judged as a failed selective cannulation of both IHDs. Results: A total of 90 patients were enrolled (0.025 group, n = 47; 0.035 group, n = 43). There was no significant difference in baseline characteristics between the groups regarding sex, age, BMI, obstruction level, and clinical presentation. Four patients (8.5%) in the 0.025 group the cannulation of the IHD failed and the conventional 0.035-inch guidewire was substituted in a second attempt; the 0.035-inch guidewire failed to cross the stricture in all four patients. In the 0.035 group, eleven patients (25.6%) failed to achieve selective cannulation of IHD, and the 0.025-inch guidewire was substituted; the newly designed 0.025-inch guidewire crossed the stricture in ten of these (10/11, 90.9%). The selective cannulation rate of IHD was significantly higher in the 0.025 group (95.1% vs. 85.5%, p = 0.043). Conclusions: The 0.025 group exhibited a higher success rate for selective cannulation of both IHDs in MHBO than did the 0.035 group. |
