ERCP Bootcamp (On-Demand) | July 2026-Chahal

Chahal_WireManagement ERCP EUS

Pdf Summary

This presentation reviews guidewire selection and handling in ERCP and interventional EUS, emphasizing that wire management is central to access, safety, therapy delivery, and rescue. The wire is often the only tool left in place during exchanges, so losing wire position can turn a manageable procedure into failure.<br /><br />Key wire variables include diameter, tip shape, hydrophilic coating length, shaft stiffness, and fluoroscopic visibility. Each should be chosen based on the specific problem: difficult branch entry, poor accessory tracking, uncertain wire position, or the need for stronger support. Smaller wires like 0.018 and 0.021 offer access in tight ducts but less support, while 0.025 is a practical balance and 0.035 provides maximum rail support for therapy.<br /><br />The presentation compares straight vs angled tips, short vs long hydrophilic segments, and floppy vs stiff shafts. Hydrophilic wires help cross tight or tortuous anatomy, but they reduce tactile feedback and increase the risk of false passage or duct injury if advanced blindly. Better fluoroscopic visibility improves safety, but loops or misleading shaft position can create false confidence.<br /><br />It provides practical selection guidance for common ERCP scenarios, such as native papilla cannulation, large stones, distal malignant strictures, hilar strictures, and pancreatic duct access. It also addresses EUS procedures including rendezvous, HGS, CDS, GE, and EDGE, stressing that wire stability, scope position, and tract safety must be managed as one system.<br /><br />A compatibility matrix and rescue strategies highlight that accessory success depends on wire size and support. Core rescue principles are: straighten the system, stabilize, redefine the lumen, then exchange if needed. Final take-home messages: never advance blind hydrophilic wires, never push through resistance, protect wire purchase before changing tools, and choose the wire you understand best.

Keywords

ERCP

interventional EUS

guidewire selection

wire management

hydrophilic coating

fluoroscopic visibility

wire support

native papilla cannulation

distal malignant stricture

rendezvous procedure