Endoscopy 2021; 53(05): E183-E184
DOI: 10.1055/a-1230-3170
E-Videos

Fractured guidewire fragment on the peripheral side of a malignant biliary obstruction: successful removal using a biliary balloon dilation catheter

Yuki Tanisaka
Department of Gastroenterology, Saitama Medical University International Medical Center, Saitama, Japan
,
Shomei Ryozawa
Department of Gastroenterology, Saitama Medical University International Medical Center, Saitama, Japan
,
Masafumi Mizuide
Department of Gastroenterology, Saitama Medical University International Medical Center, Saitama, Japan
,
Akashi Fujita
Department of Gastroenterology, Saitama Medical University International Medical Center, Saitama, Japan
,
Tomoya Ogawa
Department of Gastroenterology, Saitama Medical University International Medical Center, Saitama, Japan
,
Tatsuya Noguch
Department of Gastroenterology, Saitama Medical University International Medical Center, Saitama, Japan
,
Tomoaki Tashima
Department of Gastroenterology, Saitama Medical University International Medical Center, Saitama, Japan
› Author Affiliations
 

Fractured guidewire fragments in the bile duct need to be removed because they may lead to infected liver hematoma or cholangitis [1] [2] [3] [4]. We report the successful endoscopic removal of a fractured guidewire fragment on the peripheral side of a malignant biliary obstruction using a biliary balloon dilation catheter.

A 73-year-old woman underwent detailed tests for obstructive jaundice. Contrast-enhanced computed tomography showed a mass lesion in the hilar bile duct ([Fig. 1 a]). Endoscopic retrograde cholangiopancreatography was then performed. Cholangiography showed a stricture in the hilar bile duct ([Fig. 1 b]). We then performed peroral cholangioscopy (POCS) (SpyGlass DS; Boston Scientific, Marlborough, Massachusetts, USA) for accurate diagnosis ([Video 1]). An irregular papillary protrusion, which was the suspected malignancy, was confirmed by POCS ([Fig. 2]). A guidewire (0.025-inch diameter, 450-cm length, angled tip; VisiGlide 2; Olympus, Tokyo, Japan) was negotiated to the posterior right intrahepatic bile duct using POCS. As the guidewire was being withdrawn, it fractured. The fractured fragment was located on the peripheral side of the malignant biliary obstruction ([Fig. 3]). The narrowness of the POCS channel (1.2 mm) may have caused friction and ultimate fracturing of the guidewire. Another guidewire was placed over the guidewire fragment, and a biliary balloon dilation catheter (MaxForce; Boston Scientific) ([Fig. 4]) was then inserted. It was inflated to the diameter of the bile duct, allowing it to adhere to the guidewire fragment, and carefully pulled until the fragment was on the papilla side of the malignant biliary obstruction. Finally, the fragment was removed using forceps under direct view of POCS ([Fig. 5]).

Zoom Image
Fig. 1 Computed tomography and endoscopic retrograde cholangiopancreatography findings. a Contrast-enhanced computed tomography showing a mass lesion in the hilar bile duct (arrow). b Cholangiography showing a stricture in the hilar bile duct.

Video 1 Successful endoscopic removal of a fractured guidewire fragment on the peripheral side of a malignant biliary obstruction using a biliary balloon dilation catheter.


Quality:
Zoom Image
Fig. 2 Peroral cholangioscopy findings. An irregular papillary protrusion, which was the suspected malignancy, was confirmed by peroral cholangioscopy.
Zoom Image
Fig. 3 The guidewire fragment was located on the peripheral side of the malignant biliary obstruction.
Zoom Image
Fig. 4 Biliary balloon dilation catheter (MaxForce; Boston Scientific, Marlborough, Massachusetts, USA).
Zoom Image
Fig. 5 The removed guidewire fragment.

Although endoscopic removal of a fractured guidewire fragment has been reported [3] [5], removal from the peripheral side of the malignant biliary obstruction is thought to be difficult and has not previously been demonstrated. The shape of this balloon catheter was useful in allowing it to adhere to the guidewire fragment.

Endoscopy_UCTN_Code_CPL_1AK_2AD

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Competing interests

The authors declare that they have no conflict of interest.


Corresponding author

Yuki Tanisaka, MD, PhD
Department of Gastroenterology
Saitama Medical University International Medical Center
1397-1, Yamane
Hidaka
Saitama 350-1298
Japan   
Fax: +81-42-9844589   

Publication History

Publication Date:
02 September 2020 (online)

© 2020. Thieme. All rights reserved.

Georg Thieme Verlag KG
Rüdigerstraße 14, 70469 Stuttgart, Germany


Zoom Image
Fig. 1 Computed tomography and endoscopic retrograde cholangiopancreatography findings. a Contrast-enhanced computed tomography showing a mass lesion in the hilar bile duct (arrow). b Cholangiography showing a stricture in the hilar bile duct.
Zoom Image
Fig. 2 Peroral cholangioscopy findings. An irregular papillary protrusion, which was the suspected malignancy, was confirmed by peroral cholangioscopy.
Zoom Image
Fig. 3 The guidewire fragment was located on the peripheral side of the malignant biliary obstruction.
Zoom Image
Fig. 4 Biliary balloon dilation catheter (MaxForce; Boston Scientific, Marlborough, Massachusetts, USA).
Zoom Image
Fig. 5 The removed guidewire fragment.