ERCP guidewire can import various treatment equipment accurately into target pipeline, and reduce cannula times.
Use ERCP guidewire to exchange various instrument for more accuracy and safety. It can reduce the number of searching target bile duct or pancreatic duct repeatedly and intubating again.
If during radiography, smart knife with ERCP guidewire is directly used, decision of cutting can be made after radiography. If cutting is needed, insert ERCP guidewire into bile duct, and incision knife will not easily roll out of bile duct.
If therapy shall be conducted after cutting, insert ERCP guidewire again into bile duct or pancreatic duct and withdraw incision knife, replace with corresponding equipment, such as dilatable bougie for cholangiectasis according to illness status.
During operation process, remember that don't pull away ERCP guidewire, which shall keep short and straight state and especially avoid to form loops within duodenal lumen. Sometimes ERCP guidewire cannot enter original pipeline after abjection.
Judge direction of bile duct and pancreatic duct according to the travelling direction of ERCP guidewire, which can reduce obviously internal high pressure caused by overfilling contrast agent and reduce damage on pipe epithelium and acinus caused by toxicity of contrast agent.
Meanwhile, the tip of yellow zebra guidewire is extremely soft with hydrophile, which has little damage on pancreatic duct, so that the incidence of post-ERCP pancreatitis and hyperamylasemia reduces.
Cholangitis is another important complication of sphincterotome ERCP surgery. It is usually caused by instrument pollution, massive contrast agent injected in bile duct, inadequate drainage of bile caused by biliary stricture or biliary stone, drainage area which is less than 40% of the whole liver, etc. The germ will stay, breed and lead to infection. Once infection occurs, resist infection actively, and adopt effective drainage measures.
During radiography, ERCP guidewire enters middle of bile duct and injects contrast agent. If stone is small, put ERCP guidewire onto the stone under perspective, duct will enter along with ERCP guidewire and make contrast injection so the stone will not enter bile duct within liver, and stone extractor will enter along with guidewire in order to get small stones.
During cooperation with other equipment, pay attention to adjusting the distance between ERCP guidewire and ERCP catheter, tension of knife steel wire, and different insertion depth of saccule.
When tumor at hepatic portal vein needs double bracket or multiple brackets, use double ERCP guidewires, which can make as many drainage sites as possible, expand drainage area, reduce application of contrast agent, and decrease incidence of cholangitis within maximum.
The most common EST complication is bleeding, which is caused by many reasons, such as anatomic factor, technical factor, disease factor, etc. including disturbances of blood coagulation, acute cholangitis, or unreasonable current usage during operation, cutting papilla too fast, poor direction of cutting, as well as adopting precutting or cutting by needle knife, etc.
Perforation incidence is related to narrow papilla, diverticulum beside papilla, misdirection from cutting, etc. The risk for predict perforation includes incomplete suspicious sphincter, old age, cutting sphincter or long operation time. The cutting of sphincter has the most risk.
During EST, sometimes the papilla position is relatively deviate or annular folds of duodenal mucosa cannot be cut, ERCP guidewire can be put into bile duct to change papilla direction, so that the ideal length can be cut from ideal direction and bleeding and perforation can be avoided.
Stone and nitinol stone basket incarceration is infrequent. It mainly occurs in narrow bottom of bile duct with big and hard stone. Use net to entangle stone and incarcerate at the bottom while the net cannot be loosened or exit, once it occurs, use extracorporeal lithotripsy. However, there may be failure.
At present, our measure is entering saccule along with ERCP guidewire, inflating the saccule to the size of stone, and pulling down the saccule, if pull out of papilla smoothly, then the stone can be taken out.
If difficulty appears, put ERCP guidewire within bile duct first, and then put into net and try to get out the stone, in order to reduce incidence of incarcerated gallstones.
We shall continue to explore, summarize and improve operative skills of ERCP guidewire, flexibly apply ERCP guidewire, enhance operative skills, and reduce incidence of complications.