Shake: In order to make the tip of the ERCP guidewire go over the narrow part, shake the front and back direction slightly and advance the ERCP guidewire during the shaking process so that the tip of the ERCP guidewire can find the opening and go deep into the narrow part. The amplitude and force when shaking and advancing the ERCP guidewire should be just right;
Twisting: When the tip of the ERCP guidewire has been aligned, it is difficult to pass the ERCP guidewire simply by pushing the ERCP guidewire hard because the stenosis is severe or the narrow section is long. Twisting is divided into light twisting and heavy twisting.
In many cases, it is the organic cooperation of shaking, twisting in and out. Combined with an incision knife, stone removal balloon, catheter, and other instruments, these instruments can be used to increase the strength of the ERCP guidewire and change its direction.
Application of intubation angiography: selective insertion of the bile duct or selective insertion of the pancreatic duct, especially the intubation where the nipple is diseased or there are diverticula, diverticulum nipple, and accessory nipple next to the nipple.
Taking advantage of the elasticity, no tissue damage, and very smooth at the tip of the ERCP guidewire, the tip of the catheter is extended 1~2mm using the method of feeding and twisting and the bile duct opening can be found by the shaking of the wrist.
Application when inserting the bile duct or pancreatic duct into the deep part of the stenosis: Patients with high bile duct obstruction or pancreatic duct obstruction have difficulty crossing the stenosis and entering the deep cannula, or it is difficult to selectively enter the left or right hepatic duct. At this time, use various methods to guide the ERCP guidewire direct insertion and the loser can use a combination of stone removal balloon, incision knife, a catheter to change the direction.
Application during EST: Deep insertion of the ERCP guidewire into the bile duct can reduce the prolapse of the incision knife and avoid the accidental incision of the pancreatic duct; at the same time, it can also avoid repeated insertion of the bile duct, thereby reducing the operation time and the occurrence of pancreatitis.
It is also possible to place the ERCP guidewire in the bile duct first and adjust the cutting direction of the duodenal papilla with the help of the ERCP guidewire during the incision.
Application when removing stones: especially when removing intrahepatic bile duct stones or pancreatic duct stones, the ERCP guidewire can be used to cross the stones, and then a balloon or a basket that can be passed through the ERCP guidewire is placed along the ERCP guidewire to remove the stones. First, the ERCP guidewire can be used to remove stones after the bile duct using a basket to reduce the occurrence of stone incarceration, and it can be smoothly inserted into the nasociliary duct through the ERCP guidewire.
Application of stenosis expansion and stent placement: At this time, the ERCP guidewire should be the 0.035 guidewire. After crossing the stenosis, the stent will be placed after stepwise expansion with the spigot; for hilar stenosis, multiple stent placement is sometimes required. You can use the FUSION system, or you can first insert two ERCP guide wires into different bile ducts. First, insert a stent, then enter an ERCP guidewire, and then insert the stent. There are always two ERCP guidewires in the bile duct to complete the placement of multiple stents; in the case of double stent placement, the stent can also be placed first and then another ERCP guidewire before the stent is placed.