Transpapillary placement of an endoprosthesis with the aid of the Frimberger Varioguide.

Abstract

The guide wire, an important requisite for the placement of endoscopic transpapillary biliary prostheses, should combine two, normally incompatible, properties: a high degree of flexibility for atraumatic passage through irregular or "bent" stenoses, and a high degree of stiffness, to prevent sidewise deviation during advancement of the prosthesis. These opposing, formerly incompatible, properties are combined in a new type of guide wire, known as the Varioguide. With the aid of a tension controller, the stiffness of the Varioguide can be varied steplessly. In 88.2% of 68 patients with stenosis of the bile duct we succeeded in placing a transpapillary endoprosthesis with the Varioguide. In 13 cases in which a previous attempt with the conventional guide wire was unsuccessful, placement of the endoprosthesis was successfully accomplished with the Varioguide; the reverse was true in only a single patient. In the case of very narrow, rigid high stenoses, in which placement of a transpapillary endoprosthesis is especially difficult, the Varioguide has proved highly suitable (stenoses of the bile duct bifurcation).