Endoscopic retrograde cholangiopancreatography catheter and accessory exchange using a short hydrophilic guide wire: a prospective study

Background and study aims: Although hydrophilic guide wires can be used to facilitate stricture cannulation during endoscopic retrograde cholangiopancreatography (ERCP), some endoscopists avoid using them because of concerns about wire loss during exchange. There are no data available on the outcomes of using a short hydrophilic guide wire during ERCP. The aim of this study was to assess the outcomes of therapeutic ERCP procedures in which a short, completely hydrophilic guide wire was used exclusively.
Patients and methods: A total of 100 patients undergoing ERCP were studied prospectively. A 0.035-inch, 260-cm long, angled-tip hydrophilic wire (Terumo Glidewire) was used initially. Hydraulic catheter exchange was performed as follows: during catheter withdrawal the assistant advanced all the available wire into the catheter; a 12-ml syringe was then attached to the catheter and water was flushed under pressure to “float the wire” and maintain its position during catheter removal. Variables evaluated included exchange times and wire loss rates.
Results: A total of 223 catheter exchanges were performed, 132 (59 %) using the Olympus V-Scope (which held the wire in 62 % of cases): 15 % of exchanges were with catheters/accessories designed for short-wire use (Boston Scientific Rapid Exchange Biliary System or Rx System), and 85 % were with a variety of standard-length accessories. Overall, the mean exchange time was 26 seconds (range 6 - 90 seconds, standard deviation 12 seconds). The mean exchange time was faster with the V-Scope and with non-Rx-System accessories. Wire loss occurred in 5 % of all exchanges. Desired ductal/stricture access was achieved in all the patients.
Conclusions: Exchange of short hydrophilic wires is quick and reliable. The Olympus V-Scope is able to hold the wire in some cases. Monorail-type devices and accessories slow catheter exchange down slightly because hydraulic exchange cannot be performed using these systems.

References

• 1 Siegel J H, Pullano W. Two new methods for selective bile duct cannulation and sphincterotomy.  Gastrointest Endosc. 1987;  33 438-440
• 2 Miller G L, Laurence B H, McCarthy J H. Cannulation of the cystic duct and gallbladder.  Endoscopy. 1989;  21 223-224
• 3 McCarthy J H, Miller G L, Laurence B H. Cannulation of the biliary tree, cystic duct, and gallbladder using a hydrophilic polymer-coated steerable guide wire.  Gastrointest Endosc. 1990;  36 386-389
• 4 Fairley S K, Laurence B H. A user friendly hydrophilic guide wire [letter].  Gastrointest Endosc. 1991;  37 210
• 5 Johlin F C, Silverman W B. Hydraulic ERCP catheter and accessory exchange using a short guide wire.  Am J Gastroenterol. 2001;  96 3040
• 6 Ragunath K, Thomas L A, Cheung W Y. et al . Objective evaluation of ERCP procedures: a simple grading scale for evaluating technical difficulty.  Postgrad Med J. 2003;  79 467-470