ERCP wire systems: The long and the short of it

Table 3 Short-wire system potential drawbacks

Drawbacks
Only preliminary studies have documented the potential benefit of the short-wire systems (all systems)
Hydraulic exchange technique not plausible with RX system
Decreased pushability with the open channel design of the RX system
Inability to flush channel for hydrophilic wire use (RX system)
Inability to use smaller than 0.035 inch or angled wires when channel is torn after first device exchange (unless device is preloaded) (RX system)
Deterioration of the device after multiple exchanges (RX, Fusion systems)
No easy method for insertion of pancreatic stents (all systems)
No reliable method of locking wire (V-system)
Looping of wire between the biopsy port and the external locking device (RX, Fusion systems)
Poor guidewire visibility (V-system)
Air and bile leakage causing increased soiling of operators (RX, Fusion systems)
Wires may suspend freely in air after being locked jeopardizing operators (all systems)
Loss of visibility due to decreased distention of the duodenum (RX, Fusion systems)