Guidewire fracture during endoscopic sphincterotomy.

Aberrant current conductance during an endoscopic sphincterotomy is a potential hazard. However, such complications have remained primarily theoretical. In this case report, we describe the fracture of a 0.018" Teflon-coated guidewire while performing a sphincterotomy with a 7 French, dual-chambered papillotome. The fractured guidewire was free and loose in the biliary tree, but was subsequently retrieved with endoscopic techniques. Inspection of the papillotome revealed charring of the plastic area adjacent to the cutting wire tip. The electrocautery unit was found to be in normal operating condition after formal testing. We speculate that the papillotome was defective, allowing current flow directly from the cutting wire to the guidewire. The small diameter guidewire then allowed a greater current density, resulting in heat which eventually contributed to fracture of the guidewire. Aberrant current can be conducted over a non-insulated guidewire. This potential hazard can be avoided with an insulated (coated) guidewire or removal of a non-insulated guidewire.