Application of SpyGlass peroral choledochoscopy to the diagnosis and treatment of biliary stricture after liver transplantation / 中华消化内镜杂志

Objective:To explore the characteristics of biliary stricture after liver transplantation (LT) under SpyGlass peroral choledochoscopy and to investigate its treatment value for difficult stricture.Method:A total of 24 patients of biliary stricture after LT at the Department of Hepatobiliary Surgery, the First Affiliated Hospital of Xi'an Jiaotong University underwent SpyGlass examination from January 2019 to December 2020, 15.5 months (2-58 months) after surgery. The characteristics of different types of strictures and the selective guidewire placement results by SpyGlass were recorded and analyzed.Results:Of the 24 patients, 9 were anastomostic strictures (AS) and 15 others were non-anastomostic strictures (NAS). The main characteristic of 5 initial AS patients was scar constriction. Whether treated or not, all of the 15 NAS patients showed evident inflammatory hyperplasia in hilar bile duct under SpyGlass, 80% (12/15) of which were accompanied with intrahepatic biliary stones. The strictures disappeared with mild hyperplasia in 8 patients (4 AS and 4 NAS) whose biliary stents were extracted. Eleven patients (5 AS and 6 NAS) needed guidwire placement under SpyGlass, six (54.5%) of whom succeeded. The successful rate in AS patients was higher than that of NAS (4/5 VS 2/6).Conclusion:The main characteristic of AS is scar constriction and that of NAS is inflammatory hyperplasia. Selective guidewire placement can be achieved by SpyGlass peroral choledochoscopy with a satisfactory successful rate in the difficult AS.

A preliminary study of double guidewire technique combined with pancreatic duct stenting in preventing post-endoscopic retrograde cholangiopancreatography pancreatitis / 中华消化内镜杂志

To study the preventive effects of double guidewire technique combined with pancreatic duct stenting in preventing post-endoscopic retrograde cholangiopancreatography (ERCP) pancreatitis (PEP). Patients receiving ERCP were divided into the treatment group and the control group by random number table. In the treatment group, double guidewire technique combined with pancreatic duct stenting was applied. In the control group, selective biliary intubation was applied in the conventional way. The intubation time, PEP, hyperamylasemia and bleeding incidence were analyzed between the two groups. A total of 80 patients were enrolled in this study from January 2016 to December 2018. There were 40 cases in the treatment group and 39 cases in the control group. In the treatment group, the mean intubation time was 384±102 seconds. No PEP or bleeding during and after the operation occurred, but hyperamylasemia occurred in 2 cases. In the control group, the mean intubation time was 427±115 seconds. Hyperamylasemia occurred in 6 cases, PEP occurred in 3 cases, and 1 case of intraoperative bleeding happened in the control group. The incidence of PEP [0 VS 7.7%(3/39)]and hyperamylasemia [5.0% (2/40)VS 15.4%(6/39)] were lower in the treatment group (both P<0.05). Double guidewire technique combined with pancreatic duct stenting can successfully perform selective bile duct intubation and effectively prevent PEP.

The double J tubeless misguided by zebra guidewire into ileum: a case report / 中华泌尿外科杂志

A case of severe complications is presented that replaced the double J tubeless misguided by zebra guidewire into ileum in a patient with ureteral dermostomy, causing a ureteral ileum fistula.The result suggests improper operation of zebra guidewire could have a risk of ureteral perforation when the ureter is distorted, narrow or with inflammatory lesions.Standardized diagnosis and treatment and correct selection of guidewire can reduce the risk of ureteral perforation.

DoubleGJstentplacementinthetreatmentoflowerureteralstricturesandobstruction / 实用放射学杂志

Objective Toevaluatetheinterventionaltherapeuticefficacyoflowerureteralstricturesandobstructionbyimplantation of"doubleGJ"stentsbytheguidewiretrackwithtwowaysjointofpercutaneousnephrocentesisandurethra.Methods 45caseswith malignanttumoroflowerureteralstrictureorobstructionweretreatedwithballooncatheterdilatation,andthenthe"doubleJ"tube wasimplantedusingpercutaneousnephrostomyandurethradoublepathguidedwireorbit.Postoperativeurinevolume,renalfunction, colordopplerultrasoundandCTfollowGupwereobservedandreviewedfor3－12monthsaftersurgery.Results Thesuccessfulrate oftheoperationwas100%(45/45),withtheureteralobstructionrelievedandtheclinicalsymptomsimproved.After7days,renal functionfullyrecoveredtonormalin39patients,andsignificantlyimprovedin6patients.Conclusion Implantationof "doubleGJ"stentsbytheguidewiretrackwithpercutaneousnephrocentesisandtransurethraldoublepathisasimple,effectiveandminimallyinvasive treatmentformalignantureteralstrictureandobstruction.

Application of double coronary artery guide-wires for establishing complex pathway of interventional therapy for congenital heart diseases / 中国介入影像与治疗学

Objective: To explore the application value of double coronary artery guide-wire method in establishment complex pathway of interventional therapy for congenital heart diseases (CHD). Methods: Clinical data of 12 children with CHD were retrospectively analyzed, including 5 patients with pulmonary artery stenosis after correction of pulmonary atresia with ventricular septal defect (PA/VSD), 1 with pulmonary artery stenosis after radical repair of tetralogy of Fallot (TOF), 1 with pulmonary artery stenosis after correction of transposition of great artery (TGA), 3 patients with pulmonary atresia with major aorta pulmonary collateral arteries (MAPCAs), 1 with complex pulmonary arteriovenous fistula (PAVF) and 1 with circumflex branch of left coronary artery-right atrial fistula. The characteristics of complex pathways for interventional treatment of CHD were analyzed. Results: The pathways were successfully established with double coronary artery guide-wires in all patients. Balloon intervention was successfully performed in patients with pulmonary artery stenosis after correction of PA/VSD, radical repair of TOF and TGA underwent. Patients with pulmonary atresia with MAPCAs, complex PAVF and circumflex branch of left coronary artery-right atrial fistula underwent successfully occlusion. No major complication, such as valvular injury, vascular injury, pericardial tamponade or death occurred. Conclusion: Double coronary artery guide-wire method is safe and effective for establishing complex pathway of interventional therapy for congenital heart diseases, which has strong flexibility and can provide sufficient support through tortuous pathway to improve the successful rate of intervention, therefore being worthy of clinical popularization and application.

Coronary angioplasty in spontaneous coronary artery dissection—Strategy and outcomes

Objective To study the clinical, angiographic and technical characteristics of patients with spontaneous coronary artery dissection (SCAD) undergoing percutaneous coronary intervention (PCI). Methods This was a retrospective single center study where patients with angiographically confirmed SCAD undergoing PCI over a period of 4 years (2013–2017) were analyzed. We also sought to identify the clinical and angiographic predictors of procedural failure during PCI. Results There were a total of 42 patients with angiographically confirmed SCAD during the study period of which 16 patients (38.1%) underwent PCI. 14 out of the 16 patients (87.5%) taken up for PCI had technical success. In all patients the lesion was initially attempted to cross with a floppy wire and if unsuccessful it was escalated to a hydrophilic wire and finally to a stiff wire The SCAD lesion was crossed with a floppy wire in 71.4% of patients, with a hydrophilic wire in 14.2% and a stiff wire in 7.1% of patients. Wire escalation was required in 5 patients (31.3%) and in 60% of cases there was a technical success after wire escalation. Presence of diabetes mellitus, hypertension, dyslipidemia, smoking, coexisting atherosclerosis, diffuse nature of the lesion, and baseline Thrombolysis in Myocardial Infarction (TIMI) ≤ 2 flow did not predict procedural failure during PCI. Conclusion PCI in SCAD is associated with a fair rate of technical success in our population. Choosing an initial floppy wire and then escalating to a hydrophilic wire followed by a stiff wire is an optimal revascularization strategy.

Ultrasound exam for differentiating guidewire's misplacement into brachial artery during PICC insertion through subclavian vein / 中国实用护理杂志

Objective Introducing ultrasound exam method for detecting accidental displacement of guidewire into brachial artery during one type of PICC placement. Methods Select 145 patients with PICC placement as objects of study. During procedure, use EKG guidance for localization. After successfully inserted the needle into a vein and threaded the guidewire through the needle, then apply ultrasound to show the guidewire image to verify whether or not the guidewire is advanced into brachial artery at any moment. After the procedure, a chest X-ray is taken for location confirmation. Results 144 patient's guidewire ultrasound images were seen inside the subclavian vein. One patient's guidewire ultrasound image was shown inside the subclavian artery, which confirms it was accidentally advanced into the brachial artery during insertion. The guidewire was removed immediately, only scant bleeding occurred. Conclusions By utilizing ultrasound to show the guidewire image inside subclavian vein, it will help differentiate if it is accidentally advanced into the brachial artery at any moments during PICC insertion. It assists avoiding complications after advancing the catheter. It is easy to perform and helpful for wide clinical use.

Comparison between double guidewire technique and transpancreatic sphincterotomy technique for difficult biliary cannulation / 中华消化内镜杂志

Objective To compare the efficacy and safety of double guidewire technique ( DGT ) with transpancreatic sphincterotomy ( TPS) in cannulation of difficult biliary. Methods The data of patients undergoing endoscopic retrograde cholangiopancreatography from January 2014 to January 2016 in our hospital were retrospectively studied. DGT or TPS was performed on patients with difficult biliary cannulation and frequent unintended pancreatic cannulation. The cannulation success rate, cannulation time and complications of DGT and TPS were compared. Results Data of 237 patients with difficult biliary cannulation were collected, including 135 using DGT and 102 using TPS. The cannulation success rate was 79. 3％ (107/135) in DGT and 90. 2％ (92/102) in TPS (P=0. 023). The cannulation time was 8. 8±2. 7 min in DGT and 4. 7±1. 3 min in TPS (P=0. 017). The overall incidence of complications was 8. 9％(12/135) in DGT and 8. 8％ (9/102) in TPS (P=0. 986). Conclusion For patients with difficult biliary cannulation, TPS has higher success rate, shorter cannulation time, and similar complication rate compared with DGT. Endoscopists with skilled TPS procedure could select TPS as a preferred method in difficult biliary cannulation.

Is a safety guidewire needed for retrograde ureteroscopy? / Fio guia de segurança é necessário na ureteroscopia?

Summary Introduction: It is generally advised to have a safety guidewire (SGW) present during ureteroscopy (URS) to manage possible complications. However, it increases the strenght needed to insert and retract the endoscope during the procedure, and, currently, there is a lack of solid data supporting the need for SGW in all procedures. We reviewed the literature about SGW utilization during URS. Method: A review of the literature was conducted through April 2017 using PubMed, Ovid, and The Cochrane Library databases to identify relevant studies. The primary outcome was to report stone-free rates, feasibility, contraindications to and complications of performing intrarenal retrograde flexible and semi-rigid URS without the use of a SGW. Results: Six studies were identified and selected for this review, and overall they included 1,886 patients where either semi-rigid or flexible URS was performed without the use of a SGW for the treatment of urinary calculi disease. Only one study reported stone-free rates with or without SGW at 77.1 and 85.9%, respectively (p=0.001). None of the studies showed increased rates of complications in the absence of SGW and one of them showed more post-endoscopic ureteral stenosis whenever SGW was routinely used. All studies recommended utilization of SGW in complicated cases, such as ureteral stones associated with significant edema, ureteral stricture, abnormal anatomy or difficult visualization. Conclusion: Our review showed a lack of relevant data supporting the use of SGW during retrograde URS. A well-designed prospective randomized trial is in order.

Resumo Introdução: O uso de fio guia de segurança (FGS) costuma ser recomendado para a realização de ureteroscopia para prevenir e solucionar complicações durante o procedimento. Seu uso, porém, aumenta a força necessária para manipular o aparelho endoscópico dentro da luz ureteral e, atualmente, existe uma carência de dados consistentes que indiquem o uso do FGS em todos os procedimentos. Método: Uma revisão da literatura foi realizada em abril de 2017 utilizando as ferramentas PubMed, Ovid e The Cochrane Library para identificar estudos relevantes. O desfecho primário da análise foi reportar taxas de resolução dos cálculos, viabilidade, contraindicações e complicações relacionadas ao não uso do FGS. Resultados: Seis estudos foram incluídos na análise, totalizando 1.886 pacientes, nos quais foi realizada ureteroscopia semirrígida ou flexível sem o uso do FGS no tratamento de cálculos renais ou ureterais. Somente um estudo relatou taxa livre de cálculos com ou sem FGS, sendo 77,1 e 85,9%, respectivamente (p=0.001). Todos os estudos mostraram não haver aumento da taxa de complicação na ausência do FGS e um deles relatou aumento de estenose ureteral pós-endoscopia no grupo que utilizou o FGS. Todos os estudos recomendam o uso do FGS em casos complicados, como cálculos ureterais associados a edema de mucosa, estenose ureteral, anomalias anatômicas ou dificuldade de visualização do cálculo. Conclusão: Nossa revisão mostrou que faltam dados relevantes para justificar o uso do FGS durante a ureteroscopia.

The application of indwelling guide-wire technique in performing mechanical thrombectomy for acute cerebral artery occlusion / 介入放射学杂志

Objective To discuss the application value,safety and feasibility of indwelling guidewire technique in performing mechanical thrombectomy for acute cerebral artery occlusion.Methods The clinical data of 15 patients with acute ischemic stroke,who were treated with mechanical thromnectomy at authors' hospital during the period from December 2015 to February 2016,were retrospectively analyzed.The diseases included middle cerebral artery occlusion (n=6),internal carotid artery and middle cerebral artery occlusion (n=5) and vertebral basilar artery occlusion (n=4).Indwelling guide-wire technique was adopted to quickly and accurately determine the vascular occlusion characteristics,then,endovascular mechanical thrombectomy was carried out.Results By using indwelling guide-wire technique,the occlusive features of the diseased arteries were successfully and precisely determined.Immediate recanalization of the occluded artery was obtained in 13 patients (87％).The blood flow classification score after thrombolysis in cerebral infarction (TICI) reached 3 points in 10 patients and 2b points in 5 patients.In 2 patients,the vascular recanalization procedure failed because the thrombus load was large,the length of occluded segment was long,and the effect of mechanical thromnectomy was poor.According to American National Institutes of Health Stroke Scale (NIHSS),the evaluation score was improved from preoperative (19.2±7.0) to postoperative (6.3±3.6),the difference was statistically significant (P＜0.05).Three months after the treatment,the score measured by modified Rankin scale(mRS) was ≤2 points in 10 patients.Conclusion Mechanical thrombectomy is safe and effective for the treatment of acute cerebral artery occlusion.The indwelling guide-wire technique can safely,conveniently,quickly and accurately determine the characteristics of the occluded blood vessels,which is very helpful in assisting surgical manipulation,reducing procedure-related complications,and improving vascular recanalization rate.(J Intervent Radiol,2017,26:202-205)

Technique for retrieval of celect filters in difficult cases / 中国介入影像与治疗学

Objective To explore the techniques and strategies for the retrieval of the retractable inferior vena cava filter (IVCF).Methods Celect IVCF retrieval was not removed successfully with Gtünther Celect recovery device in 9 cases and exchange-wire-loop removal of inferior vena cava filter method were applicated.Results The longest implanted time of 9 patients was 142 days,the shortest implanted time was 37 days,and the average time was (88.67±33.85)days.Eight fil ters were successfully removed and one failed due to severe bending of inferior vena cava.Filter retrieval rate was 88.89％ (8/9).The average retrieval time was (69.89± 12.12)min (57-162 min).No perforation of the wall and contrast agent were found in all patients after the inferior vena cava angiography.Conclusion For the retrieval of the hook heavily atta ched to the IVCF,the retrieval technique of using the exchange wire into the loop method can effectively improve the retrieval rate and has a certain clinical value.

Optimal Use of Wire-Assisted Techniques and Precut Sphincterotomy

Various endoscopic techniques have been developed to overcome the difficulties in biliary or pancreatic access during endoscopic retrograde cholangiopancreatography, according to the preference of the endoscopist or the aim of the procedures. In terms of endoscopic methods, guidewire-assisted cannulation is a commonly used and well-known initial cannulation technique, or an alternative in cases of difficult cannulation. In addition, precut sphincterotomy encompasses a range of available rescue techniques, including conventional precut, precut fistulotomy, transpancreatic septotomy, and precut after insertion of pancreatic stent or pancreatic duct guidewire-guided septal precut. We present a literature review of guidewire-assisted cannulation as a primary endoscopic method and the precut technique for the facilitation of selective biliary access.

Recanalization strategy for chronic total occlusions with a new guidewire technique-The “Improved seesaw wiring” method / 中国介入心脏病学杂志

Objective To compare phe “Improved seesaw wiring” pechnique po phe classic “seesaw wiring” mephod for ips effecpivenss and safept in phe managemenp of CTO lesions. Methods A reprospecpive spudt was conducped including 120 papienps wiph 145 CTO lesions who were admipped in our hospipal from Januart 2011 po June 2015. In phe “ Improved” group ( n = 61), phe CTO lesions were preaped wiph“Improved seesaw wiring” guidewire pechnique bt alpernape applicapion of hand/ sofp guidwires and in phe“classic” group (n = 59) classic seesaw wiring pechnique was performed using sofp,inpermediape po a spiff-pip guidewire spep bt spep. Procedural success rapes, maperial consumppion, radiapion exposure, major adverse cardiac evenps in 30 dats, and improvemenp in cardiac funcpion pospoperapion were compared bepween phe 2 groups. Results The procedural success rapes bt firsp appempp was 93. 4% in phe ″Improved″ group and 77. 9% in phe “ Classic ” group and phe overall procedural success rapes were 95. 1% and 96. 6%respecpivelt. Guidewire consumppion [(3. 0 (2. 0, 4. 0) guidewires vs. 5. 0 (3. 0, 7. 0) guiderwires], X-rat exposure [(110 ± 65)min vs. (175 ± 73)min], conprasp media used [(210 ± 137)ml vs. (305 ± 148) ml] were all fewer or less in phe “Improved group” (all P < 0. 05). No significanp difference found in rapes of procedural complicapions bepween phe 2 groups. MACE rapes were lower in phe “ Improved” pechnique group (16. 4% vs. 30. 5% , P = 0. 045). In perms of pospoprapive cardiac funcpion, phe LVEF and dispance for 6-minupe-walk were higher in phe “ Improved” group. Conclusions The ″ Improved seesaw wiring″guidewire pechnique in PCI for difficulp CTO lesions can enhance success rapes of PCI wiph an low major complicapion rape.

The Prevention and Management of Post-ERCP Pancreatitis / 대한췌담도학회지

Complications that may occur after an endoscopic retrograde cholangiopancreatography (ERCP) procedure include pancreatitis, bleeding, cholangitis, cholecystis, perforation, and post-ERCP pancreatitis (PEP). Of these, PEP is the most common complication and 10% of patients can die from severe pancreatitis. Prevention of PEP requires the selection of an appropriate patient group according to their ERCP indications and a full awareness of the risk factors. The incidence rate can be reduced to some extent through medication and ERCP manipulation changes. The use of a spile through the guidewire during ERCP manipulation and temporary pancreatic duct stent insertion can be effective, and the administration of suppository NSAIDs as medication reduces the occurrence of PEP. Drugs such as glyceryl trinitrate (GTN), nafamostat, and somatostatin can be considered as the second best treatment in the cases where NSAIDs are contraindicated or where a plastic catheter cannot be inserted or fails after insertion into the pancreatic duct.

Successful Retrieval of a Fractured Guidewire during Extracorporeal Membrane Oxygenator Insertion / 대한내과학회지

Recently, the use of extracorporeal membrane oxygenation has evolved rapidly and there is potential for expanding its use. There are many complications associated with extracorporeal membrane oxygenation, but the fracture of a guidewire has been reported to be very rare during extracorporeal membrane oxygenation insertion. We describe our experience of successfully removing a fractured 0.038-inch guidewire using a catheter wedge with balloon inflation following a fracture that occurred during insertion of extracorporeal membrane oxygenation through the left femoral vein.

Single wire-guided inverted Y-shaped tracheal stent implantation under general anesthesia for the treatment of complex tracheal diseases:initial experiences in 6 cases / 介入放射学杂志

Objective To discuss the technical points and the clinical application of single wire-guided inverted Y-shaped tracheal stent implantation under general anesthesia in treating complex tracheal diseases. Methods During the period from January 2014 to October 2014 at authors’ hospital, a total of 6 patients with complex tracheal diseases received inverted Y-shaped tracheal stent implantation. The diseases included trachea-pleural fistula(n=1), trachea-esophageal fistula(n=2) and complex tracheal stenosis(n=3). Under general anesthesia and guided by DSA, inverted Y-shaped tracheal stent implantation was carried out in all the 6 patients. The results were analyzed. Results A total of 6 Y-shaped tracheal stents were used in the 6 patients, and single wire-guided implantation technique was employed in all procedures. In one case , the right branch of the Y-shaped tracheal stent was placed in the right upper lobe bronchus by mistake , and in the remaining 5 cases the stent implantation was successfully accomplished with single manipulation. Conclusion Under general anesthesia, Y-shaped tracheal stent implantation can effectively obstruct the trachea-pleural fistula and left main bronchus-esophageal fistula, and it can also quickly and significantly relieve the complex airway stenosis located at the tracheal carina region. This treatment is safe and reliable with satisfactory short-term effect. Moreover, single wire-guided manipulation is technically simpler, easier and faster than dual wire-guided manipulation. Therefore, this technique should be recommended in the clinical practice.

Clinical application of preoperative ultrasound-guided guide-wire localization in diagnosing tiny breast lesions / 介入放射学杂志

Objective To discuss the clinical application of ultrasound-guided preoperative guide-wire localization in diagnosing tiny breast lesions. Methods A total of 56 patients with impalpable tiny breast lesions were enrolled in this study . Preoperative guide-wire localization of the lesion was performed under high-frequency ultrasound guidance, which was followed by tracking resection of the lesion. The clinical data were retrospectively analyzed. Results Successful localization and complete resection of the lesion was accomplished in all 56 patients. The lesions included invasive ductal carcinoma (n=11), intraductal carcinoma (n=5), ductal carcinoma in situ (n=2), mucinous carcinoma (n=2), fibroadenoma (n=24), atypical hyperplasia (n=6), intraductal papilloma (n=4) and plasma-cell mastitis (n=2). Conclusion Ultrasound-guided preoperative guide-wire localization is a safe and reliable technique for the diagnosis of impalpable tiny breast lesions. It can precisely localize the lesion , which is very helpful for making a complete resection of the lesion and avoiding unnecessary breast injury. Therefore , this technique should be recommended in clinical practice.

Clinical application of preop erative ultrasound-guided guide-wire localization in diagnosing tiny breast lesions / 介入放射学杂志

Objective To discuss the clinical application of ultrasound-guided preoperative guide-wire localization in diagnosing tiny breast lesions. Methods A total of 56 patients with impalpable tiny breast lesions were enrolled in this study. Preoperative guide-wire localization of the lesion was performed under high-frequency ultrasound guidance, which was followed by tracking resection of the lesion. The clinical data were retrospectively analyzed. Results Successful localization and complete resection of the lesion was accomplished in all 56 patients. The lesions included invasive ductal carcinoma (n=11), intraductal carcinoma (n=5), ductal carcinoma in situ (n=2), mucinous carcinoma (n=2), fibroadenoma (n=24), atypical hyperplasia (n=6), intraductal papilloma (n=4) and plasma-cell mastitis (n=2). Conclusion Ultrasound-guided preoperative guide-wire localization is a safe and reliable technique for the diagnosis of impalpable tiny breast lesions. It can precisely localize the lesion, which is very helpful for making a complete resection of the lesion and avoiding unnecessary breast injury. Therefore, this technique should be recommended in clinical practice.

Protection effect of setting aside small balloon on coronary bifurcation lesions / 中国综合临床

Objective To explore the protective effect of a small balloon on bifurcation lesions by applying a single stent treatment of coronary bifurcation lesions strategy. Methods Fifty patients with coronary bifurcation lesions were randomly divided into A group and B group( 25 cases for each group ). Patients in A group were treated with the pre-entry protection branch guide wire to complete the main branch balloon pre-dilation,stenting,while in B group were treated with the set aside the branches of a small balloon. The information of main branch balloon pre-dilation,stenting were recorded. The blood flow slowed down,the incidence of side branch occlusion or stent placement,and the incidence of postoperative 24 h troponin I( cTnI) levels were measured. Results Nine cases(36%)in A group occurred lower branch blood flow,which due to 4 cases(16% )with significantly narrow branch stenting,2 cases(8%)with complete occlusion. There were only 2 cases(8%)with decrease branching blood flow in B group,and the difference was significant(P=0. 041, 0. 022). The cases with higher cTnI after 24 h in A group were 11( 39%),significantly higher in group B (3(12 %);P =0. 027 ). Conclusion Compared with the traditional protection guidewire,the approach of setting aside a small balloon to protect important branch can effectively prevent important branch occlusion, branch involvement due to lower incidence of myocardial infarction.

Can 0.025-inch Guidewire VisiGlideTM become a Standard in the ERCP-related Procedures : VIP Study.

Aims: With the progress of development of 0.025-inch guidewire (GW), various treatments with 0.025-inch GW have become possible. To date, however, there has been no multicenter cooperative prospective study using 0.025-inch GW VisiGlideTM as the versatile GW. This time, we decided to examine the result of the use of 0.025-inch GW VisiGlideTM as the first choice in the endoscopic retrograde cholangiopancreatography (ERCP)-related procedure without selecting the patient in a multicenter cooperative prospective study. Study Design: Multi-center single arm prospective study. Methodology: The 0.025-inch GW VisiGlideTM was used in the patients with biliopancreatic diseases requiring ERCP as the first choice to examine the accomplishment rate of procedure and the incidence of accidental symptom. Results: The accomplishment rate of procedure was 92.8% (180/194). The accidental symptoms of ERCP-related procedures were observed at 4.6% (9/194) and GW perforation was observed as a GW-related accidental symptom at 2.1% (4/194) but all the accidental symptoms resolved conservatively. Conclusion: The 0.025-inch GW VisiGlideTM has a high accomplishment rate of procedure and a low incidence of accidental symptom in its use in the ERCP-related procedure, and it was suggested that it may be available as a versatile GW. Clinical Trial Registry (UMIN000008180).