Post written by Fateh Bazerbachi, MD, from CentraCare, Interventional Endoscopy Program, St. Cloud Hospital, St. Cloud, Minnesota, USA.

Endoscopic retrograde cholangiopancreatography allows ductal stenting to alleviate symptomatic biliary or pancreatic duct strictures, and this is achieved through prosthesis placement over a guidewire.

There may be a need for stent exchange during future procedures and, in some clinical scenarios, renegotiation of complex strictures might be time-consuming and technically challenging.

We, therefore, demonstrate the steps of a previously described technique allowing guidewire tract preservation to facilitate subsequent interventions. This involves a simple approach to remove the prosthesis with the guidewire left in situ, using an over-the-wire stent exchange method. 

Although this technique has been remotely described, we felt that showing a step-by-step approach to this old, important technique, which can save significant time and effort in some scenarios, is important to new generations of therapeutic endoscopists. Further, we discussed possible beneficial clinical scenarios and some tips that might be useful to troubleshoot the steps of this method.

Other endoscopists can gain from this experience by being able to think in advance about implementing pancreatobiliary ductal stricture tract preservation technique and share the steps visually with assisting team members. For seasoned therapeutic endoscopists, we feel that this video might be of help to their assisting team members when learning the steps of the method through the provided visual aids and explanations.

Introducing the open snare over the wire outside the patient (A) and inside the duodenum lumen (B).

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