Clin Endosc.  2020 Jan;53(1):65-72. 10.5946/ce.2019.114.

Technical Reports of Endoscopic Retrograde Cholangiopancreatography Guidewires on the Basis of Physical Properties

• Kwon CI
• Koh DH
• Song TJ
• Park WS
• Lee DH
• Jeong S

• KMID: 2500907
• DOI: http://doi.org/10.5946/ce.2019.114

Abstract

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.

Keyword

Cholangiopancreatography, endoscopic retrograde; Guidewire; Technical study; model

Figure

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  Fig. 1. Typical characteristics of guidewires. (A) Structure of a 0.025-inch, hydrophilic coating guidewire (VisiGlide 2TM; Olympus Co., Tokyo, Japan). The guidewire is structurally divided into a shaft area and a tip area. The hydrophilic coating is mainly applied for the tip area, and the radio-opaque material is mainly attached to part of tip area. (B, C) Scanning electron microscopy examinations representing cross-sectional images of the 0.025-inch guidewire (VisiGlide 2TM; Olympus Co.) (B) and 0.035-inch guidewire (JagwireTM; Boston Scientific, Marlborough, MA, USA) (C).

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  Fig. 2. Basic property tests for the guidewires. (A) Measuring the minimum width of the loop when the tip of the guidewire is bent. (B) A universal testing machine (LRX plus; LLOYD Instrument Ltd., West Sussex, England) for the three-point bending test. (C) Examples of the three-point bending test. The distance between two points fixing the guidewire is fixed to 60 mm, and the maximum depth of bending point is fixed to 30 mm. (D) The bending test cannot be applied to the tip of the guidewire because of the uncheckable bending force.

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  Fig. 3. In vitro test using 3D-printed silicone tubes. (A) Concepts for the stricture models. (B) 3D modeling and fabrication of ten different types of stricture silicone models. (C) Guidewire is inserted into each silicone tube through a cannulation catheter after saline replenishing. (D) Examples of unsuccessful and successful insertion tests in a severe stricture model.

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  Fig. 4. In vitro test using a hand-made biliary tree silicone model with six-stranded intrahepatic ducts. (A) Six small-diameter silicone tubes were attached diagonally to a large-diameter silicone tube. (B) The assembled silicone tubes were attached to a 40×40-cm wide transparent board using Lego blocks. (C) A guidewire was successfully inserted into the right posterior branch through a bowing catheter.

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  Fig. 5. The change in the bending force according to the displacement of the bending point. In most of the guidewires, the slope of the bending force increased sharply in the early stage, and then the bending force was steadily maintained steadily if the bending became severe.

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