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; Hiroaki Saito; Shuichiro Shiina; Takaaki Ikari

doi:10.3390/jcm9124059

Clinical Evaluation of a Newly Developed Guidewire for Pancreatobiliary Endoscopy

J Clin Med. 2020 Dec 16;9(12):4059. doi: 10.3390/jcm9124059.

Authors

Shigeto Ishii¹, Toshio Fujisawa¹, Hiroyuki Isayama¹, Shingo Asahara², Shingo Ogiwara³, Hironao Okubo⁴, Hisafumi Yamagata⁵, Mako Ushio¹, Sho Takahashi¹, Hiroki Okawa³, Wataru Yamagata¹, Yoshihiro Okawa¹, Akinori Suzuki¹, Yusuke Takasaki¹, Kazushige Ochiai¹, Ko Tomishima¹, Hiroaki Saito⁴, Shuichiro Shiina¹, Takaaki Ikari⁵

Affiliations

¹ Department of Gastroenterology, Graduate School of Medicine, Juntendo University, Tokyo 113-8421, Japan.
² Department of Gastroenterology, Chiba Tokushukai Hospital, Chiba 274-8505, Japan.
³ Department of Gastroenterology, Juntendo University School of Medicine Urayasu Hospital, Chiba 279-0021, Japan.
⁴ Department of Gastroenterology, Juntendo University School of Medicine Nerima Hospital, Tokyo 117-8521, Japan.
⁵ Department of Gastroenterology, Tobu Chiiki Hospital, Tokyo 125-8512, Japan.

Abstract

Background: The guidewire (GW) plays an important role in pancreatobiliary endoscopy. GW quality is a critical factor in the effectiveness and efficiency of pancreatobiliary endoscopy. In this study, we evaluate a new 0.025 inch multipurpose endoscopic GW: the M-Through.

Methods: Our study was a multicenter retrospective analysis. We enrolled patients who underwent endoscopic procedures using the M-Through between May 2018 and April 2020. Patients receiving the following endoscopic treatments were enrolled: common bile duct (CBD) stone extraction, endoscopic drainage for distal and hilar malignant biliary obstruction (MBO), and endoscopic drainage for acute cholecystitis. For each procedure, we examined the rate of success without GW exchange.

Results: A total of 170 patients (80 with CBD stones, 60 with MBO, and 30 with cholecystitis) were enrolled. The rate of completion without GW exchange was 100% for CBD stone extraction, 83.3% for endoscopic drainage for MBO, and 43.3% for endoscopic drainage for cholecystitis. In unsuccessful cholecystitis cases with the original GW manipulator, 1 of 8 cases succeeded in the manipulator exchange. Including 6 cases who changed GW after the manipulator exchange, 11 of 16 cases succeeded in changing GW. There was significant difference in the success rate between the manipulator exchange and GW exchange (p = 0.03). The insertion of devices and stent placement after biliary cannulation (regardless of type) were almost completed with M-through. We observed no intraoperative GW-related adverse events such as perforation and bleeding due to manipulation.

Conclusion: The 0.025 inch M-Through can be used for endoscopic retrograde cholangiopancreatography-related procedures efficiently and safely. Our study found high rates of success without GW exchange in all procedures except for endoscopic drainage for cholecystitis. This GW is considered (1) excellent for supportability of device insertion to remove CBD stones; (2) good for seeking the biliary malignant stricture but sometimes need the help of a hydrophilic GW; (3) suboptimal for gallbladder drainage that require a high level of seeking ability.

Keywords: acute cholecystitis; common bile duct stone; guidewire; malignant biliary obstruction.