P3218 - Breaking Boundaries: Successful Retrieval of a Retained Fractured Guidewire in the Pancreatic Duct

Ana Rosa Vilela Sangay, MD¹, Ravi J. Kankotia, MD², Jorge D. Machicado, MD, PhD^2
1Eastern Virginia Medical School, Norfolk, VA; ²University of Michigan, Ann Arbor, MI

Introduction: Guidewire fracture during ERCP is an uncommon event and few cases of fracture guidewire within the pancreatic duct have been described.

Case Description/Methods: 40 year-old woman with painful chronic calcific pancreatitis, a severe stricture in the pancreatic head and pancreatic duct stones. During ERCP, an attempt was made to deploy a pancreatic stent, and during this maneuver, the most distal 15cm of a 0.25 inch straight wire fractured and remained retained inside the pancreatic duct above the stricture. This appeared coiled in the pancreatic body, with the sheared end embedded in a side branch. Numerous maneuvers were performed in attempts to remove the fractured wire. This included additional attempts of stricture dilation with a 10Fr Sohendra stent retriever and 6mm balloon dilation. Balloon sweeps were unsuccessful. We then attempted grabbing the wire with different instruments including a snare, a forceps, and a cytology brush with a Spybite forceps through one of the catheter lumens, which at some point was able to grab the wire but could not pull this distally. Pancreatoscopy was attempted but the catheter could not be passed across the severe stricture. After numerous attempts and prolonged procedure, as 5Fr by 9cm plastic stent was placed. The patient was brought back for ERCP after a month, which demonostrated the persistent fractured wire in the pancreatic duct. The decision was made to place a 6 cm covered metal biliary stent across the severe PD stricture. Pancreatoscopy was then performed, advancing the catheter through the metal stent into the upstream pancreatic duct, where the fractured wire was seen as well as intraductal stones. The fractured wire was grabbed numerous times with the Spyforceps, but this could not be pulled through the pancreatoscopy probe channel or be pulled out of the duct by pulling the pancreatoscopy probe out. The fractured wire was moved upstream the pancreatic duct with the Spyforceps. The pancreatoscopy was removed and a rath tooth forceps was advanced through the covered metal stent. Under fluoroscopy guidance, the fractured end of the wire was grabbed with a rath tooth forceps and the fractured wire was retrieved from the patient

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Ana Rosa Vilela Sangay, MD¹, Ravi J. Kankotia, MD², Jorge D. Machicado, MD, PhD². P3218 - Breaking Boundaries: Successful Retrieval of a Retained Fractured Guidewire in the Pancreatic Duct, ACG 2023 Annual Scientific Meeting Abstracts. Vancouver, BC, Canada: American College of Gastroenterology.