Refinement of ERCP by using the Olympus V-scope system with a 0.025 in. compatible and complete fixable Visiglide(®) guidewire

Comparison of guidewires for successful cannulation of biliary stenosis and targeting of biliary branches in ERCP

Background and study aims Guidewires play a crucial role in endoscopic retrograde cholangiopancreatography. The ability to pass through stenosis, and the ability to seek the desired biliary branch are particularly important. In this study, we aimed to compare these specific abilities in various guidewires by using a bile duct model. Patients and methods Seven 0.025-inch angle-type guidewires (VisiGlide2, Fielder 25, EndoSelector, NaviPro, Jagwire Plus, RevoWave DualMaster, and J-WIRE prologue ST) were evaluated. To compare these, a bile duct silicone model was prepared. The time from the entry of the guidewire into the common bile duct with the stenosis to the emergence of the guidewire from the common bile duct after reaching two target intrahepatic bile duct branches was measured. Results VisiGlide 2 and Fielder 25 were the fastest guidewires, whereas Jagwire Plus was the slowest. Conclusions In this study, a guidewire with a tip deflection height of approximately 9 mm and a hydrophilic coating length of 7 to 8 cm achieved the fastest completion time for the course. In clinical practice, it is important to consider the performance required in various scenarios and to select the most appropriate guidewire. The results of this model test, which focused on the time required to complete the course around the model, can serve as a foundation for guidewire selection. This method holds potential utility in future guidewire development.

Clinical Evaluation of a Newly Developed Guidewire for Pancreatobiliary Endoscopy

Background: The guidewire (GW) plays an important role in pancreatobiliary endoscopy. GW quality is a critical factor in the effectiveness and efficiency of pancreatobiliary endoscopy. In this study, we evaluate a new 0.025 inch multipurpose endoscopic GW: the M-Through. Methods: Our study was a multicenter retrospective analysis. We enrolled patients who underwent endoscopic procedures using the M-Through between May 2018 and April 2020. Patients receiving the following endoscopic treatments were enrolled: common bile duct (CBD) stone extraction, endoscopic drainage for distal and hilar malignant biliary obstruction (MBO), and endoscopic drainage for acute cholecystitis. For each procedure, we examined the rate of success without GW exchange. Results: A total of 170 patients (80 with CBD stones, 60 with MBO, and 30 with cholecystitis) were enrolled. The rate of completion without GW exchange was 100% for CBD stone extraction, 83.3% for endoscopic drainage for MBO, and 43.3% for endoscopic drainage for cholecystitis. In unsuccessful cholecystitis cases with the original GW manipulator, 1 of 8 cases succeeded in the manipulator exchange. Including 6 cases who changed GW after the manipulator exchange, 11 of 16 cases succeeded in changing GW. There was significant difference in the success rate between the manipulator exchange and GW exchange (p = 0.03). The insertion of devices and stent placement after biliary cannulation (regardless of type) were almost completed with M-through. We observed no intraoperative GW-related adverse events such as perforation and bleeding due to manipulation. Conclusion: The 0.025 inch M-Through can be used for endoscopic retrograde cholangiopancreatography-related procedures efficiently and safely. Our study found high rates of success without GW exchange in all procedures except for endoscopic drainage for cholecystitis. This GW is considered (1) excellent for supportability of device insertion to remove CBD stones; (2) good for seeking the biliary malignant stricture but sometimes need the help of a hydrophilic GW; (3) suboptimal for gallbladder drainage that require a high level of seeking ability.

A prospective randomized study of thin versus regular-sized guide wire in wire-guided cannulation

BACKGROUND

Endoscopic retrograde cholangiopancreatography (ERCP) is a valuable tool in the diagnosis and management of various pancreatobiliary disorders. Our aim was to evaluate whether the combination of a thin guide wire and a thin sphincterotome would facilitate selective cannulation of the bile duct and reduce the incidence of post-ERCP pancreatitis (PEP) by reducing papillary trauma when compared with a regular-sized hydrophilic guide wire.

METHODS

Between June 2011 and February 2012, we performed 100 biliary cannulations for a native papilla in a randomized controlled trial. Having given their written informed consent, patients were randomly assigned to a 0.025-inch guide wire and sphincterotome group (n = 50) or to a 0.035-inch guide wire and sphincterotome group (n = 50). Number of cannulation attempts, number of accidental guide wire passages into the pancreatic duct, secondary cannulation techniques after failed primary cannulation, time to change the technique, and time for successful cannulation were collected in a database. Patients were followed up after ERCP, and all post-ERCP complications were recorded.

RESULTS

Primary cannulation was successful in 80 %. With accessory techniques, cannulation of the biliary duct was achieved in every case except one. There was no difference in primary cannulation rate between the 0.025-inch and 0.035-inch wire groups (n = 40 in each group). PEP was diagnosed in two patients (2.0 %), one in each study group. Postsphincterotomy bleeding occurred in one patient (1.0 %).

CONCLUSIONS

The thickness of the hydrophilic guide wire does not appear to affect either the success rate of primary cannulation or the risk of complications.