Endoscopy 2019; 51(03): E59-E60
DOI: 10.1055/a-0820-1160
E-Videos
© Georg Thieme Verlag KG Stuttgart · New York

Peroral cholangiopancreatoscopy as a rescue method for a trapped pancreatic guidewire

Rodrigo Mansilla-Vivar
1  Digestive Endoscopy Unit, Digestive Diseases Department, La Fe Polytechnic University Hospital, Valencia, Spain
2  Gastrointestinal Endoscopy Research Group, IIS Hospital La Fe, Valencia, Spain
3  Digestive Endoscopy Unit, Hospital Puerto Montt, Puerto Montt, Chile
,
Noelia Alonso-Lázaro
1  Digestive Endoscopy Unit, Digestive Diseases Department, La Fe Polytechnic University Hospital, Valencia, Spain
2  Gastrointestinal Endoscopy Research Group, IIS Hospital La Fe, Valencia, Spain
,
Lidia Argüello-Viudez
1  Digestive Endoscopy Unit, Digestive Diseases Department, La Fe Polytechnic University Hospital, Valencia, Spain
2  Gastrointestinal Endoscopy Research Group, IIS Hospital La Fe, Valencia, Spain
,
Marta Ponce Romero
1  Digestive Endoscopy Unit, Digestive Diseases Department, La Fe Polytechnic University Hospital, Valencia, Spain
2  Gastrointestinal Endoscopy Research Group, IIS Hospital La Fe, Valencia, Spain
,
Marco Bustamante-Balen
1  Digestive Endoscopy Unit, Digestive Diseases Department, La Fe Polytechnic University Hospital, Valencia, Spain
2  Gastrointestinal Endoscopy Research Group, IIS Hospital La Fe, Valencia, Spain
,
Vicente Pons Beltrán
1  Digestive Endoscopy Unit, Digestive Diseases Department, La Fe Polytechnic University Hospital, Valencia, Spain
2  Gastrointestinal Endoscopy Research Group, IIS Hospital La Fe, Valencia, Spain
› Author Affiliations
Further Information

Corresponding author

Rodrigo Mansilla-Vivar, MD, MHA
Gastrointestinal Endoscopy Research Group
IIS Hospital La Fe
Avda. Fernando Abril Martorell, n: 106
46126 Valencia
Spain   
Fax: +34-64-5157931   

Publication History

Publication Date:
11 January 2019 (eFirst)

 

Peroral cholangiopancreatoscopy is an endoscopic technique that enables direct visual examination and video-guided tissue sampling. The technique has improved the ability to identify pancreaticobiliary diseases and has been useful for treating complex bile and pancreatic duct stones [1] [2] [3]. It is increasingly being used as a therapeutic procedure [4].

We present the case of a 55-year-old man with a history of chronic calcifying pancreatitis of alcoholic etiology. He was admitted for resolution of symptomatic pancreatic lithiasis using endoscopic retrograde cholangiopancreatography. To our knowledge, there are no reports of rescue maneuvers using cholangiopancreatoscopes.

During the procedure, the ascending duodenal part was hardly reached owing to a tortuous duct due to the chronic pancreatitis. The guidewire was placed in the pancreatic duct at the first attempt. Initially without the use of contrast, pancreatic calcifications were observed in the fluoroscopic image. After opacification, a very dilated Wirsung duct (10 mm) was observed, and stones were confirmed in the pancreas body and tail ([Fig. 1 a]). Sphincterotomy and cleaning of the main pancreatic duct were performed. During the cleaning maneuvers, we could not withdraw the guidewire from the pancreatic tail as it had become trapped between the stones. Despite the use of standard force, the pancreatic guidewire could not be mobilized ([Fig. 1 b]). Sphincteroplasty with a balloon was performed, followed by pancreatoscopy with the SpyGlass system (Boston Scientific, Marlborough, Massachusetts, USA). Under direct view it was possible to see the guidewire impacted between pancreatic stones. We started to wash through the SpyGlass working channel to move the stones and were eventually able to release the guidewire ([Video 1]). Lithotripsy was then performed using a laser, and most, but not all, of the stone fragments were extracted. Finally, a plastic prosthesis (9 cm × 10 Fr) was inserted.

Zoom Image
Fig. 1 Fluoroscopy. a Dilated tortuous pancreatic duct. b Trapped guidewire in the pancreatic tail.

Video 1 Peroral cholangiopancreatoscopy showing endoscopic maneuvers to rescue a trapped pancreatic guidewire.

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Competing interests

Dr. Pons Beltrán has received fees for serving as a consultant for Boston Scientific.


Corresponding author

Rodrigo Mansilla-Vivar, MD, MHA
Gastrointestinal Endoscopy Research Group
IIS Hospital La Fe
Avda. Fernando Abril Martorell, n: 106
46126 Valencia
Spain   
Fax: +34-64-5157931   


Zoom Image
Fig. 1 Fluoroscopy. a Dilated tortuous pancreatic duct. b Trapped guidewire in the pancreatic tail.