The fellows' cornerGuidewires in ERCP
Section snippets
Wire specifications
The basic structure of the guidewire consists of a monofilament core with an outer coating. The core material for the monofilament is typically composed of nitinol, which has largely replaced stainless steel. The monofilament is covered with an outer sheath made of polytetrafluoroethylene (PTFE, or Teflon) or polyurethane, synthetic hydrophobic materials, enabling the smooth exchange of devices over the wire. The distal tip, or business end, of the guidewire is coated with an additional
Long-wire system
The need for the long wire at the inception of ERCP was dictated by the fact that this length was needed to exchange the various devices needed for the procedure.3 The endoscopic assistant requires training and experience to be adept at manipulating the guidewire. In addition, excellent communication is needed between the physician and the assistant. This may make using the long-wire system a challenge at facilities that do not have experienced staff available. Difficulties between physician
Safety considerations
The primary complication associated with guidewire use during ERCP is perforation. The main site at risk for guidewire-related perforation is the biliary tree. A large retrospective study of 6620 ERCPs identified 7 guidewire-related perforations.6 All were recognized during the procedure and were managed medically, with only 1 patient requiring a biliary stent. Concern for electrical injury transmitted from the cutting sphincterotomy wire to the guidewire is more of a historical concern because
Costs
All of the guidewires used in ERCP are disposable, single-use items. In many cases, there is no significant difference in price between the various lengths and diameters of the guidewires. However, the short-wire method is generally more expensive than the long-wire technique because of the relatively higher costs of the short-wire accessories, including balloons, baskets, stent deployment systems, and brushes, in comparison with their analogous counterparts in the traditional long-wire system.
Conclusion
Guidewires play a critical role in ERCP in cannulating the papillae, facilitating selective access to the desired duct, and enabling exchange of devices. They may also serve to reduce post-ERCP pancreatitis—one of the feared complications of the procedure. Although specific benefits are associated with both the short-wire and the long-wire systems, the key difference between them is the degree of physician control over the guidewire. Ultimately, the physician's experience and preferences with
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Cited by (4)
American Society for Gastrointestinal Endoscopy guideline on post-ERCP pancreatitis prevention strategies: methodology and review of evidence
2023, Gastrointestinal EndoscopyCitation Excerpt :Cost-effectiveness data are lacking for the comparison of wire versus contrast-guided access. Although some cost is incurred by using different wires and accessories such as locking devices, this cost is potentially offset by the greater cost of PEP with contrast-guided methods.34 The patient representative had no strong opinions regarding discomfort or preference for wire-guided versus contrast-guided cannulation but valued the reduced risk of PEP with the former strategy.
ERCP standard and special devices
2020, Endotherapy in Biliopancreatic Diseases: ERCP Meets EUS: Two Techniques for One VisionWire-guided biliary cannulation: A comprehensive approach to a set of techniques
2019, European Journal of Gastroenterology and HepatologyEndoscopic sphincterotomy for choledocholithiasis
2018, Choledocholithiasis: Comprehensive Surgical Management