ERCP Bootcamp: Cutting Edge Comprehensive Training for the Team

Noonan_Wire Management

Pdf Summary

This presentation explains the importance of guidewire management in advanced endoscopy. Guidewires are essential for fluoroscopy-guided procedures such as ERCP, EUS-guided interventions, enteral stenting, and stricture dilation because they provide access, stability, and support during device exchange while helping reduce procedural trauma.<br /><br />The talk reviews key guidewire characteristics, including diameter, core material, coating, and tip shape. Stainless steel wires are stiffer and better for maintaining position and stent delivery, while nitinol wires are more flexible and useful in fragile or narrow ducts. Hydrophilic coatings reduce friction and help with difficult cannulation, whereas PTFE or hybrid coatings offer better grip and tactile feedback. Wires may also have straight or angled tips depending on the anatomy and clinical goal.<br /><br />The presentation compares short-wire and long-wire techniques. In short-wire systems, the physician controls the wire at the scope, while in long-wire systems, an assistant manages the external wire, requiring strong communication to prevent loss of access. Fundamental principles include confirming the wire’s type and length before use, advancing gently without force, maintaining visualization, and coordinating carefully during exchanges.<br /><br />Specific guidance is given for ERCP and EUS-guided procedures, including selective biliary cannulation, pancreatic wire-assisted techniques, double-wire methods, rendezvous access, and gallbladder drainage. Troubleshooting tips include reassessing anatomy, changing wire stiffness or tip shape, and avoiding repeated traumatic attempts.<br /><br />Common complications include loss of access, perforation, kinking, fracture, and false passage. Prevention centers on controlled movements, keeping hydrophilic wires wet, avoiding blind advancement, and stopping when resistance or damage is detected.<br /><br />Overall, the key message is that successful wire management depends on choosing the right wire, maintaining continuous control, and ensuring strong communication among the endoscopist, assistant, and fluoroscopy team.

Keywords

guidewire management

advanced endoscopy

ERCP

EUS-guided interventions

fluoroscopy-guided procedures

biliary cannulation

hydrophilic coating

nitinol wire

stainless steel wire

wire exchange techniques