Korean J Gastroenterol.  2023 Jan;81(1):36-39. 10.4166/kjg.2022.121.

Guidewire Impaction in the Main Pancreatic Duct in a Patient with Chronic Pancreatitis: A Case Report

• Kim S
• So H
• Jung SW
• Bang SJ

• KMID: 2538686
• DOI: http://doi.org/10.4166/kjg.2022.121

Abstract

The guidewire is an essential accessory in ERCP. Although rare, guidewires can cause complications, such as subcapsular hepatic hematoma, perforation, knotting, fracture, and impaction, during ERCP. This report describes a guidewire impaction during the endoscopic treatment of a patient with symptomatic chronic pancreatitis. The methods used to treat guidewire impaction are not well known. In the present case, the impacted guidewire was retrieved by inserting another guidewire and dilating the space adjacent to it. Endoscopists should check for the free movement of the guidewire before stent deployment. Additionally, it is important to ask for help from experienced senior staff to overcome any challenges during the procedure. In conclusion, endoscopists should be aware of the possibility of a guidewire impaction during ERCP.

Keyword

Cholangiopancreatography; endoscopic retrograde; Pancreatitis; chronic

Figure

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  Fig. 1 (A) Contrast-enhanced axial computed tomography image shows large pancreaticoliths obstructing the main pancreatic duct. (B) Magnetic resonance projection image of the pancreaticoliths and dilated main pancreatic duct.

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  Fig. 2 Fluoroscopic image during endoscopic retrograde cholangiopancreatography. (A) Pancreatic duct with filling defect caused by pancreaticoliths. It was not possible to pass the guidewire (VisiGlide2®, 0.025 inches, straight type; Olympus, Tokyo, Japan) through the stricture. (B) The impacted guidewire could not be removed, and the stent (Zimmon®, 7 Fr, 5 cm, single pigtail; COOK, Limerick, Ireland) was stuck between the scope and the impacted site. (C) A Soehendra® stent retriever (8.5 Fr; COOK Medical, Bloomington, IN, USA) was used to dilate the stricture and release the impacted guidewire. (D) Another plastic stent (Zimmon®, 7 Fr, 9 cm, single pigtail; COOK) was deployed after the successful removal of the impacted guidewire.

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