Post written by Rintaro Fukuda, MD, and Naminatsu Takahara, MD, PhD, from the Department of Gastroenterology, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan, and Yousuke Nakai, MD, PhD, from the Department of Endoscopy and Endoscopic Surgery, Graduate School of Medicine, The University of Tokyo.

Retained guidewire is not a rare adverse event during endoscopic and percutaneous interventions for pancreatobiliary diseases. In this video case, we demonstrate removal of a retained guidewire using a novel device.

A 58-year-old man underwent percutaneous transhepatic biliary drainage to assess the cause of a solitary biliary stricture in the right posterior branch (B7), but the guidewire was retained because of shearing at the needle tip.

During subsequent ERCP, a novel tapered sheath dilator (EndoSheather; Piolax Medical Devices, Kanagawa, Japan), which allows insertion of devices up to 1.9 mm in diameter, was inserted into B7 across the stricture, and pediatric biopsy forceps (Radial Jaw 4P Biopsy Forceps; Boston Scientific Japan, Tokyo, Japan) were advanced through the outer sheath after removing the inner catheter.

We successfully grasped and retrieved the retained guidewire using the biopsy forceps under fluoroscopic guidance without adverse events. The stricture located at B7 was pathologically confirmed to be benign. 

Our video case shows this tapered sheath dilator can be a new option for retrieval of a foreign body above a biliary stricture. A cholangioscope did not work well in a limited space of the intrahepatic bile duct, and the conventional technique in combination with a new device was useful in this specific condition. 

This case illustrates the practical application of a novel device in a difficult situation where other devices did not work. We believe this device “repositioning” can be unexpectedly useful, similar to drug repositioning. 

The retained guidewire was removed successfully using a novel tapered sheath dilator and biopsy forceps.

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