Hybrid short-wire ERCP technique, five years of experience

Abstract

Backgrounds: The aim of this work is to present the novel hybrid endoscopic retrograde cholangiopancreatography (ERCP) technique using short guidewires and accessories designed for long and short systems. The technique is based on the internal locking capability of the short guidewire, assistant wire control and the possibility of targeting the wire by a physician. Material and methods: ERCPs were performed with Olympus duodenoscopes, using a short guidewire (260–270\u2005cm) and accessories designed for short- and long-wire systems. The speed of deployment of the accessories and incidence of post-ERCP pancreatitis (PEP) when using the short-wire hybrid technique were compared with the same parameters when using a long-wire system. The success of cannulations, the percentage of bleeding and cholangitis were monitored. Results: From 2016 to 2020, a total number of 1,506 ERCPs were done. Hybrid technique was used in 58.2% (2017), 88.5% (2018), 91.3% (2019) and 98.5% (2020) of the procedures. The cannulation success rate was 94.73%. The average accessory insertion times through the working channel were 15 s (cv = 0.12, σ = 1.91) when using a short guidewire and a V-system, 31 s (cv = 0.08, σ = 2.67) when using a long guidewire and a V-system and 55 s (cv = 0.06, σ = 3.34) when using a long guidewire and an endoscope without a locking device. The rate of complications was 5.26% and none of them was severe. A lower incidence of PEP with a short guidewire than with a long one (1% vs. 4%, P = 0.033) was demonstrated. Conclusion: Our retrospective analysis of the ERCP hybrid technique highlights faster deployment of accessories and a lower PEP rate compared to the long-wire method. We noticed low bleeding and infectious complications apparently due to easy and quick handling of the short guidewire.