ERCP wire systems: The long and the short of it

Table 1 Differences between the three short-wire systems

Characteristics	RX system	Fusion system	V-system
Type of endoscope	Standard	Standard	V-scope
Type of lock	External at the biopsy port	External at the biopsy port	Internal lock design
Type of device	Open channel tear-away	Close channel breakthrough	Close lumen device
Short–track technology	Yes	Yes	No
Wire length	260 cm	185 cm	270 cm
Can be used with standard guidewires	Yes	Yes	Yes
Can be used with 0.025” or 0.018” or angled wires	No	Yes	Yes
Can be used with hydrophilic Glidewire	No	Yes	Yes
Ability to flush wire channel	No	Yes	Yes
Intraductal exchange ability	No	Yes	No
Insertion of multiple stents without the need to recannulate	No	Yes	No
Physician control of wire	Yes	Yes	Yes
Pushability of short-wire devices1	++	+++	+++

¹author own experience.

Table 2 Short-wire system potential advantages

Advantages
Reduced exchange times
Reduced stent insertion times
Maintenance of ductal access
Reduction of sedation and fluoroscopy time
Increased endoscopist control of cannulation
Locking of wire in position to increase stability
Decreased rates of post-ERCP pancreatitis
Decreased trauma when ampullary surface is manipulated
Reduced rates of wire adjustments
Aids in stricture access
Allows placements of multiple stents (Fusion system only)

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)