Endoscopy 2018; 50(10): E279-E280
DOI: 10.1055/a-0641-4989
E-Videos
© Georg Thieme Verlag KG Stuttgart · New York

Successful endoscopic removal of fractured guidewire fragments from a peripheral bile duct using a biliary stent delivery system and biopsy forceps

Yoshihiro Nishikawa
Department of Gastroenterology and Hepatology, Graduate School of Medicine, Kyoto University, Kyoto, Japan
,
Norimitsu Uza
Department of Gastroenterology and Hepatology, Graduate School of Medicine, Kyoto University, Kyoto, Japan
,
Yuki Yamauchi
Department of Gastroenterology and Hepatology, Graduate School of Medicine, Kyoto University, Kyoto, Japan
,
Akihisa Fukuda
Department of Gastroenterology and Hepatology, Graduate School of Medicine, Kyoto University, Kyoto, Japan
,
Yoshihide Ueda
Department of Gastroenterology and Hepatology, Graduate School of Medicine, Kyoto University, Kyoto, Japan
,
Yuzo Kodama
Department of Gastroenterology and Hepatology, Graduate School of Medicine, Kyoto University, Kyoto, Japan
,
Hiroshi Seno
Department of Gastroenterology and Hepatology, Graduate School of Medicine, Kyoto University, Kyoto, Japan
› Author Affiliations
Further Information

Corresponding author

Norimitsu Uza, MD
Department of Gastroenterology and Hepatology
Kyoto University Graduate School of Medicine
54 Kawara-cho, Shogoin, Sakyo-ku
Kyoto
Japan   
Fax: +81-75-7514302   

Publication History

Publication Date:
03 July 2018 (eFirst)

 

A 61-year-old man with sclerosing cholangitis was referred to our hospital. Blood tests on admission suggested he had acute cholangitis. An abdominal radiograph revealed, in addition to two plastic biliary stents, a foreign body in the upper abdominal area, which appeared to be a fractured guidewire fragment in a peripheral bile duct that had remained after endoscopic retrograde cholangiopancreatography (ERCP) performed at the previous hospital ([Fig. 1]).

Zoom Image
Fig. 1 Abdominal radiograph showing two plastic biliary stents and a foreign body.

A further ERCP was performed in our facility for acute cholangitis and removal of the fragments. Cholangiography revealed a biliary stricture from the hilar to peripheral bile ducts, in which guidewire fragments were identified ([Fig. 2]). After the duct had been dilated with a 7-Fr dilator (Soehendra dilation catheter; Cook Japan, Japan), the introducer tube and pusher tube of a biliary stent delivery system (Gadelius Medical, Japan) ([Fig. 3]) were inserted. Once the tip of the pusher tube reached the fragments, the introducer tube was withdrawn and the guidewire fragments were removed through the pusher tube with biopsy forceps (Radial Jaw 4 Pediatric Biopsy Forceps; Boston Scientific Japan, Japan) ([Fig. 4] and [Fig. 5]; [Video 1]). Finally, endoscopic nasobiliary drainage tubes were placed in the bilateral hepatic ducts. The patient’s acute cholangitis improved following this procedure.

Zoom Image
Fig. 2 Cholangiographic image showing a biliary stricture from the hilar to peripheral bile ducts, in which the fractured guidewire fragments were seen.
Zoom Image
Fig. 3 Photograph of the introducer tube and pusher tube of the biliary stent delivery system used in this technique. Both devices have radiopaque markers on the tip.
Zoom Image
Fig. 4 Radiographic image showing forceps inserted to remove the guidewire fragments through the pusher tube.
Zoom Image
Fig. 5 The removed guidewire fragments.

Video 1 The procedure for removal of the guidewire fragments using the introducer and pusher tube of a biliary stent delivery system and biopsy forceps.

Georg Thieme Verlag. Please enable Java Script to watch the video.

Although there are several reports of fractured guidewires being present in the bile ducts, removal of guidewire fragments from a peripheral bile duct has not previously been reported [1] [2] [3] [4]. To remove the fragments, we modified the previously reported method for a “mapping biopsy” of the bile duct using a Soehendra dilation catheter and biopsy forceps [5]. This technique can deliver various devices to the target site easily and accurately. In addition, it may decrease the risk of acute pancreatitis by reducing the burden on the duodenal papilla that is caused by the frequent insertion and removal of devices.

In conclusion, we report a novel technique to retrieve a foreign body, such as a fractured guidewire fragment, from a peripheral bile duct.

Endoscopy_UCTN_Code_TTT_1AR_2AG

Endoscopy E-Videos is a free access online section, reporting on interesting cases and new techniques in gastroenterological endoscopy. All papers include a high quality video and all contributions are freely accessible online.
This section has its own submission website at https://mc.manuscriptcentral.com/e-videos


#

Competing interests

None


Corresponding author

Norimitsu Uza, MD
Department of Gastroenterology and Hepatology
Kyoto University Graduate School of Medicine
54 Kawara-cho, Shogoin, Sakyo-ku
Kyoto
Japan   
Fax: +81-75-7514302   


Zoom Image
Fig. 1 Abdominal radiograph showing two plastic biliary stents and a foreign body.
Zoom Image
Fig. 2 Cholangiographic image showing a biliary stricture from the hilar to peripheral bile ducts, in which the fractured guidewire fragments were seen.
Zoom Image
Fig. 3 Photograph of the introducer tube and pusher tube of the biliary stent delivery system used in this technique. Both devices have radiopaque markers on the tip.
Zoom Image
Fig. 4 Radiographic image showing forceps inserted to remove the guidewire fragments through the pusher tube.
Zoom Image
Fig. 5 The removed guidewire fragments.