Wire-guided sphincterotomy

Guidewire-assisted techniques have acquired an important role in endoscopic interventions in the pancreaticobiliary tree. The wire-guided sphincterotome allows the endoscopist to maintain direct access to the biliary tree before or after the sphincterotomy. It has the additional advantages of allowing for more expeditious placement of accessories and being useful in combined percutaneous-endoscopic procedures. There are two basic designs of wire-guided sphincterotomes. The single-channel model has a single lumen for both the cutting wire and guidewire and requires guidewire removal before the application of power. The double-channel model has two separate lumens for the guidewire and stainless steel cutting wire. In vitro data suggest that significant capacitive coupling currents (or short circuits) may occur on the standard Teflon-coated guidewire when used with a double lumen sphincterotome, resulting in electrosurgical burns. Thus, the manufacturers of the double-lumen models recommend removing the Teflon-coated wire before performing sphincterotomy. Although limited data in humans have been published, it appears that wire-guided sphincterotomy and standard sphincterotomy have similar complication rates. More safety information in humans is awaited.