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Guidewire fracture during endoscopic sphincterotomy
J S Burdick1, M J Schmalz, J E Geenen
1Gastroenterology Consultants Ltd., Racine, Wisconsin.
Endoscopy
|March 1, 1993
Summary
A guidewire fractured during endoscopic sphincterotomy due to aberrant electrical current. Using insulated guidewires or removing non-insulated ones can prevent this rare but serious complication.
Area of Science:
- Gastroenterology
- Endoscopic Procedures
- Medical Device Safety
Background:
- Endoscopic sphincterotomy carries a risk of aberrant electrical current.
- Complications from aberrant current during procedures have been largely theoretical.
Observation:
- A Teflon-coated guidewire fractured during a 7 French dual-chambered papillotome-assisted sphincterotomy.
- The fractured guidewire was retrieved from the biliary tree.
- The papillotome showed charring near the cutting wire, suggesting a defect.
Findings:
- Electrocautery unit testing confirmed normal function.
- A defective papillotome likely allowed current to flow to the guidewire.
- The small-diameter guidewire experienced high current density, leading to heat and fracture.
Implications:
- Aberrant current can conduct through non-insulated guidewires.
- Using insulated guidewires or removing non-insulated ones mitigates this risk.
- This case highlights a practical safety concern in endoscopic retrograde cholangiopancreatography (ERCP).