Clinical Endoscopy

Original Articles

Puncture angle on an endoscopic ultrasound image is independently associated with unsuccessful guidewire manipulation of endoscopic ultrasound-guided hepaticogastrostomy: a retrospective study in Japan: Akihisa Ohno, Nao Fujimori, Toyoma Kaku, Kazuhide Matsumoto, Masatoshi Murakami, Katsuhito Teramatsu, Keijiro Ueda, Masayuki Hijioka, Akira Aso, Yoshihiro Ogawa; Clin Endosc 2024;57(5):656-665. Published online July 26, 2024; DOI: https://doi.org/10.5946/ce.2023.244

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Background
/Aims: Although endoscopic ultrasound-guided hepaticogastrostomy (EUS-HGS) is performed globally, the procedure remains challenging. Guidewire manipulation is the most difficult step, and there are few reports on the factors associated with unsuccessful guidewire manipulation. This study aimed to assess the significance of the puncture angle on EUS images and identify the most effective guidewire rescue method for patients with unsuccessful guidewire manipulation.
Methods
We retrospectively enrolled 115 patients who underwent EUS-HGS between May 2016 and April 2022 at two centers. The puncture angle between the needle and the intrahepatic bile duct was measured through EUS movie records.
Results
Guidewire manipulation was unsuccessful in 28 patients. Receiver operating characteristic (ROC) curves identified an optimal puncture angle cutoff value of 85° (cutoff value, 85°; area under the ROC curve, 0.826; sensitivity, 85.7%; specificity, 81.6%). Multivariate analysis demonstrated that a puncture angle <85° was a significant risk factor for unsuccessful guidewire manipulation (odds ratio, 19.8; 95% confidence interval, 6.42–61.5; p<0.001). Among the 28 unsuccessful cases, 24 patients (85.7%) achieved successful guidewire manipulation using various rescue methods.
Conclusions
The puncture angle observed on EUS is crucial for guidewire manipulation. A puncture angle of <85° was associated with unsuccessful guidewire manipulation.

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Backward leap technique using a novel 0.018-inch guidewire
Kosuke Takahashi, Eisuke Ozawa, Yasuhiko Nakao, Masanori Fukushima, Hisamitsu Miyaaki, Kazuhiko Nakao
Endoscopy.2025; 57(S 01): E90. CrossRef
The Role and Appropriate Selection of Guidewires in Biliopancreatic Endoscopy
Daniele Alfieri, Claudia Delogu, Stefano Mazza, Aurelio Mauro, Erica Bartolotta, Alessandro Cappellini, Davide Scalvini, Francesca Torello Viera, Marco Bardone, Andrea Anderloni
Medicina.2025; 61(5): 913. CrossRef

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Double-guidewire technique for selective biliary cannulation does not increase the rate of post-endoscopic retrograde cholangiopancreatography pancreatitis in patients with naïve papilla: Han Taek Jeong, June Hwa Bae, Ho Gak Kim, Jimin Han; Clin Endosc 2024;57(2):226-236. Published online January 26, 2024; DOI: https://doi.org/10.5946/ce.2023.128

Graphical Abstract Abstract PDF PubReader ePub: Background
/Aims: This study aimed to compare the safety of the double-guidewire technique (DGT) with that of the conventional single-guidewire technique (SGT) in real-world situations.
Methods
A total of 240 patients with naïve papilla who underwent endoscopic retrograde cholangiopancreatography (ERCP) at Daegu Catholic University Medical Center between January 2021 and December 2021 were included. The primary outcome was the rate of post-ERCP pancreatitis (PEP) in the SGT and DGT groups.
Results
A total of 163 patients (67.9%) belonged to the SGT group, and 77 (32.1%) belonged to the DGT group. The rates of successful biliary cannulation were 95.7% and 83.1% in the SGT and DGT groups, respectively (p=0.002). In the study group, PEP occurred in 14 patients (5.8%). The PEP rates were not significantly different between the SGT and DGT groups (4.3% vs. 9.1%, p=0.150). In the multivariate analysis, the age of <50 years (odds ratio [OR], 9.305; 95% confidence interval [CI], 1.367–63.358; p=0.023) and hyperlipidemia (OR, 7.384; 95% CI, 1.103–49.424; p=0.039) were significant risk factors for PEP in the DGT group.
Conclusions
DGT did not increase the PEP rate in patients with naïve papilla. In addition, the age of <50 years and hyperlipidemia were significant risk factors for PEP in the DGT group.

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Technical Reports of Endoscopic Retrograde Cholangiopancreatography Guidewires on the Basis of Physical Properties: Chang-Il Kwon, Dong Hee Koh, Tae Jun Song, Won Suk Park, Dong Hang Lee, Seok Jeong; Clin Endosc 2020;53(1):65-72. Published online August 6, 2019; DOI: https://doi.org/10.5946/ce.2019.114

Abstract PDF PubReader ePub

Background
/Aims: Using an appropriate guidewire can increase the success rate of selective cannulation in endoscopic retrograde cholangiopancreatography. The purpose of this technical study was to investigate the characteristics of each guidewire type and to evaluate its efficiency and rapidity of insertion.
Methods
We conducted a three-point bending test using a universal testing machine to investigate the flexibility and bending features of each guidewire. 3D-printed silicone tubes with various types of stricture and a hand-made biliary tree silicone model with six-stranded intrahepatic ducts were used to evaluate the success rate and insertion time of each guidewire.
Results
In the three-point bending test, the characteristics of each guidewire were classified. We found that the bending strengths and times were independent of shaft thickness. Using two in vitro biliary duct models, we determined that the success rate and total insertion time were better for guidewires with a resilient shaft and angled tip than for other types of guidewires (p<0.001). Although thickness of the guidewire affected the success rate (p<0.05), it did not affect the total insertion time (p≥0.05).
Conclusions
Among several types of guidewire, some factors (resilient shaft, highly flexible, and angled tip) appeared to be associated with the efficiency and rapidity of the guidewire insertion.

Citations

Citations to this article as recorded by

Japanese Multi‐Institution Study of Success Rates of Wire‐Guided Biliary Cannulation During Endoscopic Retrograde Cholangiopancreatography in Relation to Guidewire tip Length (With Video)
Takeshi Ogura, Yuki Tanisaka, Masanari Sekine, Katsumasa Kobayashi, Hirotsugu Maruyama, Shinji Hirai, Hideyuki Shiomi, Minoru Shigekawa, Masaki Kuwatani, Kenji Ikezawa, Masahiro Itonaga, Mamoru Takenaka, Susumu Hijioka, Tsukasa Ikeura, Shinpei Doi, Nao Fu
DEN Open.2026;[Epub] CrossRef
The Role and Appropriate Selection of Guidewires in Biliopancreatic Endoscopy
Daniele Alfieri, Claudia Delogu, Stefano Mazza, Aurelio Mauro, Erica Bartolotta, Alessandro Cappellini, Davide Scalvini, Francesca Torello Viera, Marco Bardone, Andrea Anderloni
Medicina.2025; 61(5): 913. CrossRef
Structural factors influencing the clinical performance of 0.025-inch guidewires for pancreatobiliary endoscopy: An experimental study
Takehiko Koga, Naoaki Tsuchiya, Yusuke Ishida, Takanori Kitaguchi, Keisuke Matsumoto, Makoto Fukuyama, Satoki Kojima, Norihiro Kojima, Fumihito Hirai
Endoscopy International Open.2024; 12(05): E666. CrossRef
Guidewire Impaction in the Main Pancreatic Duct in a Patient with Chronic Pancreatitis: A Case Report
Soyoung Kim, Hoonsub So, Seok Won Jung, Sung Jo Bang
The Korean Journal of Gastroenterology.2023; 81(1): 36. CrossRef
Efficacy of a newly developed guidewire for selective biliary access
Do Hyun Park, Joung-Ho Han, Tae Hoon Lee, Jae Kook Yang, Ji Sung Lee, Yong Hun Lee, Mamoru Takenaka, Sang-Heum Park
Scientific Reports.2023;[Epub] CrossRef
Efficacy of a Newly Developed Guidewire for Selective Biliary Cannulation: A Multicenter Randomized Controlled Trial
Sung Yong Han, Sung Ill Jang, Dong Hee Koh, Jong Hyun Lee, Dong Uk Kim, Jae Hee Cho, Kyong Joo Lee, Seong-Hun Kim, Min Je Sung, Chang-Il Kwon
Journal of Clinical Medicine.2023; 12(10): 3440. CrossRef
Comparison of Two Types of Guidewires for Malignant Hilar Biliary Obstruction by Endoscopic Retrograde Cholangiopancreatography: A Randomized Controlled Trial
Sung Yong Han, Jung Wan Choe, Dong Uk Kim, Jong Jin Hyun, Joung-Ho Han, Hoonsub So, Sung Jo Bang, Dong Hee Koh, Seok Jeong
Journal of Clinical Medicine.2023; 12(10): 3590. CrossRef
Comparison of guidewires for successful cannulation of biliary stenosis and targeting of biliary branches in ERCP
Masanori Kobayashi, Hiromune Katsuda, Kazuo Ohtsuka, Ryuichi Okamoto
Endoscopy International Open.2023; 11(09): E805. CrossRef
Impact of guidewire caliber on ERCP outcomes: Systematic review and meta-analysis comparing 0.025- and 0.035-inch guidewires
Muhammad Aziz, Amna Iqbal, Zohaib Ahmed, Saad Saleem, Wade Lee-Smith, Hemant Goyal, Faisal Kamal, Yaseen Alastal, Ali Nawras, Douglas G. Adler
Endoscopy International Open.2022; 10(07): E990. CrossRef
Experimental study of loop shape using 0.025-inch ERCP guidewires (with videos)
Takeshi Ogura, Saori Ueno, Atsushi Okuda, Nobu Nishioka, Tadahiro Yamada, Masanori Yamada, Kazuya Ueshima, Jun Matsuno, Yoshitaro Yamamoto, Kazuhide Higuchi
Endoscopy International Open.2021; 09(03): E427. CrossRef
Technical Review of Developments in Endoscopic Ultrasound-Guided Hepaticogastrostomy
Takeshi Ogura, Kazuhide Higuchi
Clinical Endoscopy.2021; 54(5): 651. CrossRef
Difficult Biliary Cannulation in Endoscopic Retrograde Cholangiopancreatography: Definitions, Risk Factors, and Implications
Brian M. Fung, Teodor C. Pitea, James H. Tabibian
EMJ Hepatology.2021; : 64. CrossRef
Production of ERCP training model using a 3D printing technique (with video)
Chang-Il Kwon, Yeonsun Shin, Jaeok Hong, Minje Im, Guk Bae Kim, Dong Hee Koh, Tae Jun Song, Won Suk Park, Jong Jin Hyun, Seok Jeong
BMC Gastroenterology.2020;[Epub] CrossRef
Clinical Evaluation of a Newly Developed Guidewire for Pancreatobiliary Endoscopy
Shigeto Ishii, Toshio Fujisawa, Hiroyuki Isayama, Shingo Asahara, Shingo Ogiwara, Hironao Okubo, Hisafumi Yamagata, Mako Ushio, Sho Takahashi, Hiroki Okawa, Wataru Yamagata, Yoshihiro Okawa, Akinori Suzuki, Yusuke Takasaki, Kazushige Ochiai, Ko Tomishima,
Journal of Clinical Medicine.2020; 9(12): 4059. CrossRef

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Reviews

Optimal Use of Wire-Assisted Techniques and Precut Sphincterotomy: Tae Hoon Lee, Sang-Heum Park; Clin Endosc 2016;49(5):467-474. Published online September 19, 2016; DOI: https://doi.org/10.5946/ce.2016.103

Abstract PDF PubReader ePub

Various endoscopic techniques have been developed to overcome the difficulties in biliary or pancreatic access during endoscopic retrograde cholangiopancreatography, according to the preference of the endoscopist or the aim of the procedures. In terms of endoscopic methods, guidewire-assisted cannulation is a commonly used and well-known initial cannulation technique, or an alternative in cases of difficult cannulation. In addition, precut sphincterotomy encompasses a range of available rescue techniques, including conventional precut, precut fistulotomy, transpancreatic septotomy, and precut after insertion of pancreatic stent or pancreatic duct guidewire-guided septal precut. We present a literature review of guidewire-assisted cannulation as a primary endoscopic method and the precut technique for the facilitation of selective biliary access.

Citations

Citations to this article as recorded by

Clinical application of ERCP concurrent laparoscopic cholecystectomy in the treatment of cholecystolithiasis complicated with extrahepatic bile duct stones
Jiang-Bo Shen, Peng-Cheng Chen, Jin-Gen Su, Qing-Chun Feng, Pei-Dong Shi
Heliyon.2024; 10(10): e31022. CrossRef
Efficacy of a newly developed guidewire for selective biliary access
Do Hyun Park, Joung-Ho Han, Tae Hoon Lee, Jae Kook Yang, Ji Sung Lee, Yong Hun Lee, Mamoru Takenaka, Sang-Heum Park
Scientific Reports.2023;[Epub] CrossRef
Factors Predicting Difficult Biliary Cannulation during Endoscopic Retrograde Cholangiopancreatography for Common Bile Duct Stones
Hirokazu Saito, Yoshihiro Kadono, Takashi Shono, Kentaro Kamikawa, Atsushi Urata, Jiro Nasu, Haruo Imamura, Ikuo Matsushita, Tatsuyuki Kakuma, Shuji Tada
Clinical Endoscopy.2022; 55(2): 263. CrossRef
Management of difficult or failed biliary access in initial ERCP: A review of current literature
Qinghai Chen, Peng Jin, Xiaoyan Ji, Haiwei Du, Junhua Lu
Clinics and Research in Hepatology and Gastroenterology.2019; 43(4): 365. CrossRef
Comparison of efficacy and safety of transpancreatic septotomy, needle-knife fistulotomy or both based on biliary cannulation unintentional pancreatic access and papillary morphology
Jun Wen, Tao Li, Yi Lu, Li-Ke Bie, Biao Gong
Hepatobiliary & Pancreatic Diseases International.2019; 18(1): 73. CrossRef
Wire-guided biliary cannulation: a comprehensive approach to a set of techniques
Vincenzo Cennamo, Marco Bassi, Stefano Landi, Cecilia Binda, Carlo Fabbri, Stefania Ghersi, Antonio Gasbarrini
European Journal of Gastroenterology & Hepatology.2019; 31(11): 1299. CrossRef
TRANSPAPILLARY ENDOSCOPIC SURGERY: COMPLICATIONS AND PREVENTION OF THEIR DEVELOPMENT
P N Romashchenko, A A Filin, N A Maistrenko, A A Fekliunin, E S Zherebtsov
Bulletin of the Russian Military Medical Academy.2019; 21(1): 54. CrossRef
Modified transprepancreatic septotomy reduces postoperative complications after intractable biliary access
Henggao Zhong, Xiaohong Wang, Lihua Yang, Lin Miao, Guozhong Ji, Zhining Fan
Medicine.2018; 97(1): e9522. CrossRef

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Preparation of High-Risk Patients and the Choice of Guidewire for a Successful Endoscopic Retrograde Cholangiopancreatography Procedure: Tae Hoon Lee, Young Kyu Jung, Sang-Heum Park; Clin Endosc 2014;47(4):334-340. Published online July 28, 2014; DOI: https://doi.org/10.5946/ce.2014.47.4.334

Abstract PDF PubReader ePub

Endoscopic retrograde cholangiopancreatography (ERCP) is an essential technique for the diagnosis and treatment of pancreatobiliary diseases. However, ERCP-related complications such as pancreatitis, cholangitis, hemorrhage, and perforation may be problematic. For a successful and safe ERCP, preprocedural evaluations of the patients and intervention-related risk factors are needed. Furthermore, in light of the recent population aging and increase in chronic cardiopulmonary diseases in Korea, precautions including endoscopic sedation and prevention of cardiopulmonary complications should be considered. In this literature review, we describe these risk factors and the use of endoscopic sedation. In addition, we reviewed the commonly available guidewires, including their materials and options, used as a basic accessory for ERCP procedures.

Citations

Citations to this article as recorded by

The Role and Appropriate Selection of Guidewires in Biliopancreatic Endoscopy
Daniele Alfieri, Claudia Delogu, Stefano Mazza, Aurelio Mauro, Erica Bartolotta, Alessandro Cappellini, Davide Scalvini, Francesca Torello Viera, Marco Bardone, Andrea Anderloni
Medicina.2025; 61(5): 913. CrossRef
Structural factors influencing the clinical performance of 0.025-inch guidewires for pancreatobiliary endoscopy: An experimental study
Takehiko Koga, Naoaki Tsuchiya, Yusuke Ishida, Takanori Kitaguchi, Keisuke Matsumoto, Makoto Fukuyama, Satoki Kojima, Norihiro Kojima, Fumihito Hirai
Endoscopy International Open.2024; 12(05): E666. CrossRef
Racial disparities in endoscopic retrograde cholangiopancreatography (ERCP) utilization in the United States: are we getting better?
Dushyant Singh Dahiya, Abhilash Perisetti, Neil Sharma, Sumant Inamdar, Hemant Goyal, Amandeep Singh, Laura Rotundo, Rajat Garg, Chin-I Cheng, Sailaja Pisipati, Mohammad Al-Haddad, Madhusudhan Sanaka
Surgical Endoscopy.2023; 37(1): 421. CrossRef
Comparison of guidewires for successful cannulation of biliary stenosis and targeting of biliary branches in ERCP
Masanori Kobayashi, Hiromune Katsuda, Kazuo Ohtsuka, Ryuichi Okamoto
Endoscopy International Open.2023; 11(09): E805. CrossRef
Prevention of Post-ERCP Pancreatitis: Pro-gress in Different Procedural Techniques
永烜张
Advances in Clinical Medicine.2022; 12(11): 10124. CrossRef
Bedside Percutaneous Approach in a Critically Ill ICU Patient with Complex Pancreatobiliary Disorder Followed by Endoscopic Approach: Lessons Learnt from a Tertiary Referral Center
Cosmas Rinaldi Adithya Lesmana, Caecilia Herjuningtyas, Sri Inggriani, Yulia Estu Pratiwi, Laurentius A. Lesmana
Case Reports in Gastroenterology.2021; 15(1): 210. CrossRef
Technical Reports of Endoscopic Retrograde Cholangiopancreatography Guidewires on the Basis of Physical Properties
Chang-Il Kwon, Dong Hee Koh, Tae Jun Song, Won Suk Park, Dong Hang Lee, Seok Jeong
Clinical Endoscopy.2020; 53(1): 65. CrossRef
PREDICTIVE FACTORS FOR POST-ERCP BLEEDING. INFLUENCE OF DIRECT ORAL ANTICOAGULANTS
Ernesto Parras Castañera, Pelayo Rodríguez López, Alberto Álvarez Delgado, Fernando Muñoz Núñez, Fernando Geijo Martínez, Antonio Velasco Guardado
Revista Española de Enfermedades Digestivas.2020;[Epub] CrossRef
Current approaches to the treatment of complications of endoscopic transpapillary interventions
S. G. Shapovaliyants, S. A. Budzinskiy, E. D. Fedorov, M. V. Bordikov, M. A. Zakharova
Annaly khirurgicheskoy gepatologii = Annals of HPB Surgery.2019; 24(2): 74. CrossRef
Efficacy of midazolam‐ versus propofol‐based sedations by non‐anesthesiologists during therapeutic endoscopic retrograde cholangiopancreatography in patients aged over 80 years
Su Jung Han, Tae Hoon Lee, Sang‐Heum Park, Young Sin Cho, Yun Nah Lee, Yunho Jung, Hyun Jong Choi, Il‐Kwun Chung, Sang‐Woo Cha, Jong Ho Moon, Young Deok Cho, Sun‐Joo Kim
Digestive Endoscopy.2017; 29(3): 369. CrossRef
Pancreatic Stenting Reduces Post-ERCP Pancreatitis and Biliary Sepsis in High-Risk Patients: A Randomized, Controlled Study
He-Kun Yin, Hai-En Wu, Qi-Xiang Li, Wei Wang, Wei-Lin Ou, Harry Hua-Xiang Xia
Gastroenterology Research and Practice.2016; 2016: 1. CrossRef
Optimal Use of Wire-Assisted Techniques and Precut Sphincterotomy
Tae Hoon Lee, Sang-Heum Park
Clinical Endoscopy.2016; 49(5): 467. CrossRef
Highlights from the 50th Seminar of the Korean Society of Gastrointestinal Endoscopy
Eun Young Kim, Il Ju Choi, Kwang An Kwon, Ji Kon Ryu, Seok Ho Dong, Ki Baik Hahm
Clinical Endoscopy.2014; 47(4): 285. CrossRef

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Four Cases of Guidewire Induced Periampullary Perforation During Endoscopic Retrograde Cholangiopancreatography: Tae Hoon Lee, M.D., Sang-Heum Park, M.D., Bum Suk Son, M.D., Baek Gyu Jun, M.D., Jun Young Eun, M.D., Jae Yun Kim, M.D., Sae Hwan Lee, M.D. and Sun-Joo Kim, M.D.; Korean J Gastrointest Endosc 2011;42(5):334-340. Published online May 28, 2011

Abstract PDF: Duodenal perforation associated with endoscopic retrograde cholangiopancreatography is very uncommon. However, it usually requires early diagnosis and surgical management. Perforations are commonly caused by endoscopic sphincterotomy, biliary or duodenal stent placement, guidewire-related causes, and endoscopy itself. Perforatioins can follow various clinical courses, and management depends on the cause of the perforation. Among the above causes, guidewire-induced perforation is very rare and related reports and analyses are limited. Herein we describe four cases of guidewire-induced periampullary perforation during endoscopic retrograde cholangiopancreatography, and analyze clinical characteristics and management. (Korean J Gastrointest Endosc 2011;42:334-340)

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Two Cases of Direct Peroral Cholangioscopy Using an Ultra-Slim Upper Endoscope Endoscopic after Stone Removal: Jong Chan Lee, M.D., Jong Ho Moon, M.D., Bong Min Go, M.D., Hyun Jong Choi, M.D., Hyun Cheol Koo, M.D., Young Koog Cheon, M.D., Young Deok Cho, M.D., Joon Seong Lee, M.D., Moon Sung Lee, M.D., Chan Sup Shim, M.D. and Boo Sung Kim, M.D.; Korean J Gastrointest Endosc 2007;35(5):373-376. Published online November 30, 2007

Abstract PDF: Peroral cholagioscopy is a good procedure that permits direct visualization of the biliary tree and target biopsies of lesions. However, peroral cholangioscopy with a mother- baby system requires two experienced endoscopists, and the procedure remains time consuming and expensive and the apparatus is easily broken. Therefore, an easier technique to get direct visual examination of the biliary tree is needed. Direct peroral cholangioscopy (direct POC) with using an ultra-slim upper endoscope was performed in two patients after endoscopic stone removal for diagnosing their biliary stricture. One patient had wire-guided direct POC performed and the patient was diagnosed benign biliary stricture on the proximal CBD after forcep biopsy. Another patient had overtube-assisted direct POC performed and that patient was found to have a polypoid lesion at the bifurcation. Future advances in endoscope development, as well as specifically designed accessories, are expected to increase its clinical utility. Korean J Gastrointest Endosc 2007;35: 373-377)

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Endoscopic Removal of a Spoon from the Stomach Using Guidewire: Byung Wook Lim, M.D., Young Soo Moon, M.D., Sang Eun Lee, M.D., Tae Nyun Kim, M.D., Kyung Ah Kim, M.D., Hyun Bae Son, M.D., Jeon Ho Yang, M.D., Jeong Rak Lee, M.D.* and Kyung Tae Kim, M.D.*; Korean J Gastrointest Endosc 2004;29(1):17-21. Published online July 30, 2004

Abstract PDF: Foreign body ingestion is a relatively uncommon, but potentially serious condition. Most of gastrointestinal foreign bodies pass spontaneously. But, large objectives are usually lodged in the stomach and cause perforation, bleeding, and obstruction. Therefore, prompt retrieval of lodged foreign bodies are necessary before complications develop. Particularly, in the case of long metallic spoon, there have been no cases of spontaneous passage reported. Therefore, prompt retrieval of a metallic spoon are necessary. A 28- year-old woman with schizophrenia who ingested a long spoon for suicidal attempt was referred to our hospital. Simple abdomen showed a 18 cm sized long, metallic spoon with saw-toothed end placed in the stomach. We removed a spoon by an endoscopic technique and an extraction maneuver using a guidewire and a Magill forceps. (Korean J Gastrointest Endosc 2004;29:17⁣21)

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