Pure Wire Guided Cannulation of the Bile Duct Using a Loop-tip Guidewire
Comments: In this video we will present two cases discussing the technique of bile duct access with pure wire guided cannulation using a loop tip guide wire. For pure wire guided cannulation, a sphincterotome is recommended. We should stay slightly away from the papilla so that papilla is clearly visualized and using the bow of sphincterotome the guide wire can be advanced in a cephalad direction over the septum in the direction of the bile duct. Loop-tip guidewire is a 0.035 inch guide wire with an atraumatic tip . The loop at end prevents dissection of the tissue and prevents puncturing of pancreatic duct. The radio-opacity of the guide wire tells us the duct accessed without injecting contrast. Also, the guide wire has enough stiffness for adequate pushing force. This schematic diagram shows how the bow of the sphincterotome is used to get an upward angulation.
This is a 21-year-old female patient who presented with right upper quadrant abdominal pain with abnormal liver enzymes. Right upper quadrant sonogram showed gall stones and a dilated bile duct. Here you can visualize the papilla. Once the sphincterotome is in the duodenum; the guide wire is moved to make sure there is free movement. Using the bow of the sphincterotome the guide wire is directed towards the bile duct and advanced over the septum. A few extra minutes are spent to angulate the wire towards the bile duct. Fluoroscopically the guide wire can be seen passing into the bile duct. Subsequently the sphincterotome can be slowly advanced over the guide wire into the bile duct to complete the therapy.
In another example; a 79 year old patient presented with obstructed jaundice from a pancreatic head mass. A normal appearing prominent papilla is visualized. The sphincterotome is advanced and the guide wire is moved to assess for free movement. Again, staying away from the papilla the bow of the sphincterotome is used to align in the direction of the bile duct. Using the movement of the wheels and the bow of the tome, the tip of the sphincterotome is aligned in the direction of the bile duct. Once adequate angle is achieved the guide wire is slowly advanced over the septum into the bile duct. The direction of the guide wire is confirmed with fluoroscopy. The sphincterotome is advanced over the guide wire into the bile duct and contrast is injected and therapy completed. These two cases illustrate a simple and effective technique of bile duct access using a loop tip guide wire and technique of pure wire guided cannulation.
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Kapil Gupta, M.D. Assistant Professor of Medicine Hennepin County Medical Center University of Minnesota |
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Citation: Gupta, K. (Dec 08 2009). Pure Wire Guided Cannulation of the Bile Duct Using a Loop-tip Guidewire. The DAVE Project. Retrieved Jul, 30, 2010, from http://daveproject.org/viewfilms.cfm?film_id=888 Times viewed since Feb 2006: 5064 |
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