P1067 - Thermal Changes in Guidewires Used During Endoscopic Retrograde Cholangiopancreatography During Electrical Conductance: An Ex Vivo Safety Experiment

Rahul Karna, MD¹, Nicholas McDonald, MD², Théoden I. Netoff, PhD³, Jacob Weiner, BS⁴, Stuart K. Amateau, MD, PhD, FACG^1
1University of Minnesota Medical Center, Minneapolis, MN; ²Thomas Jefferson University, Philadelphia, PA; ³University of Minnesota, Minneapolis, MN; ⁴University of Minnesota Medical School, Minneapolis, MN

Introduction: Double wire cannulation can be used for biliary cannulation during endoscopic retrograde cholangiopancreatography (ERCP). During sphincterotomy, the wire maintaining access to the alternative duct may come into contact with the cutting wire of the sphincterotome, in theory allowing electrical conduction and thermal injury. Similarly, during endoscopic ampullectomy, snare may contact the guidewire with a wire guided approach. We aimed to evaluate heat generated from the commercially available guidewires to assess safety.

Methods: We tested the heat generation of eleven wires used in ERCP: Glidewire 0.018”, Glidewire 0.025”, Glidewire 0.035” (Terumo Interventional Systems, Somerset, NJ), Metro Wire 0.021” (Cook Medical, Bloomington, IN), Visiglide 0.025” (Olympus, Center Valley, PA), Revowave 0.025” (Olympus, Center Valley, PA), Novagold 0.018” (Boston Scientific, Marlborough, MA), Jagwire 0.035” (Boston Scientific, Marlborough, MA), JagRevolution 0.025” (Boston Scientific, Marlborough, MA), Hydrojag 0.035” (Boston Scientific, Marlborough, MA ), Road Runner 0.018” (Cook Medical, Bloomington, IN). A polypectomy snare was connected to the wire. An Erbe electrosurgical generator (Erbe, Marietta, GA) with settings ENDO CUT Q (effect 2, cut duration 2, cut interval 3) and ENDO CUT I (effect 2, cut duration 2, cut interval 3) was utilized as the energy source. Then the wire was placed into a basin of water (initial temperature: 17.3 ° C), with a multimeter next to the wire measuring temperature. We also applied current to the wires outside of the basin of water to evaluate for a visible spark.

Results: Eleven wires were tested for heat generated and for the presence of a spark from electrical conductance via an electrical surgical generator (Table 1). The max change in temperature was 4.3° C with ENDO CUT Q settings and 6.8° C with ENDO CUT I settings. Despite this change, the max temperature reached was 24.8° C. Two wires: Glidewire 0.018” and Visiglide 0.025” produced large sparks down the length of the wire.

Discussion: In our ex vivo study, minimal heat was generated via electrical conductivity and we suspect temperatures generated were not high enough to cause thermal injury. Magnified imaging of the Visiglide demonstrated pinpoint defects in the coating fluorine coating with similar defects found in the thin Glidewire coating. (Figure 1) Of interest, wires expected to conduct energy, such as those with minimal coating or gold tips appear safe despite contact with the cautery wire.



Disclosures:


Rahul Karna, MD¹, Nicholas McDonald, MD², Théoden I. Netoff, PhD³, Jacob Weiner, BS⁴, Stuart K. Amateau, MD, PhD, FACG¹. P1067 - Thermal Changes in Guidewires Used During Endoscopic Retrograde Cholangiopancreatography During Electrical Conductance: An Ex Vivo Safety Experiment, ACG 2024 Annual Scientific Meeting Abstracts. Philadelphia, PA: American College of Gastroenterology.