ERCP wire systems: The long and the short of it

Abstract

Guidewires are routinely used at the time of endoscopic retrograde cholangiopancreatography (ERCP) to gain and maintain access to the desired duct and aid in the advancement of various devices. Limitations of the traditional long-wire systems have led to the introduction of three proprietary short-wire systems. These systems differ in many respects but share two main principles: They lock a shorter wire in position to allow advancement or removal of various devices without displacement of the wire and they all allow for physician control of the wire. In this comprehensive review, we describe the key features of the three currently available short-wire systems: RX, Fusion and V systems. We also focus on the potential benefits and drawbacks that accompany the short-wire concept as a whole and each specific system in particular. Although the available data are limited, it appears that the use of the short-wire systems lead to reduced procedure, fluoroscopy and device exchange times, decreased sedation requirements, improved wire stability and increased endoscopist control of the wire. Furthermore, the physician-controlled wire-guided cannulation has the potential to decrease ampullary trauma and the rate of post-ERCP pancreatitis. The short guidewire systems appear to be an improvement over the traditional long-wire systems but further studies directly comparing the two approaches are needed.

Endoscopic retrograde cholangiopancreatography (ERCP): core curriculum

“…They should understand the advantages and disadvantages of each system. 24,25 For example, advantages of the short-wire system include the ability to lock the wire into place for stability, improve the rate of device exchange, and the option for the endoscopist to manage his or her own wire (which is especially beneficial for endoscopists who do not have assistants skilled in wire management). Disadvantages include incompatibility with some long-wire devices and difficulties in performing exchanges with hydrophilic wires.…”

A new guidewire cannulation technique in ERCP: successful deep biliary access with triple-lumen sphincterotome and guidewire controlled by the endoscopist

“…Contrast medium can be injected later, without removing the guidewire, thus decreasing the procedure, sedation, and fluoroscopy times [23,25,26]. In some difficult cases, the endoscopist can gently advance the wire and inject contrast alternatively to secure cannulation; all of the operations are performed by the endoscopist personally.…”

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“…These are controlled by the endoscopist shorten procedural time, decrease trauma at the papilla and reduce PEP. In a prospective randomized trial, 25 using short GWs, the mean exchange time was significantly reduced in the short GW group compared to long GW group.…”