SAGES Magazine

THE SOUTH AFRICAN GASTROENTEROLOGY REVIEW 2022 | VOLUME 20 | ISSUE 3 | 44 ERCP | A GUIDE FOR NURSES AND ASSISTANTS | Re-printed with permission WH I C H B I T S O F K I T T O U S E ? It’s fair to say that each operator probably does things a little differently to reach the same goal, and there are no methods that are more correct than others if the goal is reached safely and tolerably for the patient. I am frequently asked why I use certain equipment and not others. I will explain the differences between techniques and equipment and why I prefer some to others, but each operator will have equally valid reasons for choosing the equipment they are most comfortable with. It is important that you are confident and familiar with the equipment you are using as well. If you are unclear about something then it’s best to say so before the procedure starts. Long wire or short wire? What’s the difference? Long wire systems were in place for many years before short wire systems came into use 10 or more years ago. As you may guess the long wire technique is where the guide wire is typically over 400cm long and the sphincterotomes, balloons, stents and brushes are threaded down the entire length of the wire. Short wire systems (the wire is about half the length of a long wire) allow the instruments to be threaded along a short length of the wire to speed up the change of equipment and reduce the likelihood of the end of the wire slipping out of the bile duct during this process, as the wire is locked in place at the biopsy channel of the endoscope. The disadvantage for some years of short wire systems was that there was less choice of equipment that could be used and the ‘feel’ of the wire during cannulation was diminished, but this has improved over recent years. There are lots of different brands of equipment - how do you choose? The hardest part of the procedure (particularly when learning) is the initial cannulation of the bile duct, and if this is not carried out then the procedure has to stop. The cannulae used for cannulating the ampulla come in different shapes, all of which I have tried over the years, and for this reason I tend to favour COOK DomeTip equipment as I find the rounded tip slides more easily into the bile duct. 18