The application of guidewire technique: shaking, in order to make the tip of the guidewire cross the stenosis, the front and back direction slightly shaking, and in the shaking process to advance the guidewire, so that the tip of the guidewire to find the opening deep into the stenosis, shaking and advancing the guidewire amplitude and force should be just right; twisting into, when the tip of the guidewire has been aligned, due to the more serious stenosis or stenosis section is long, simply force to advance the guidewire difficult to pass, the use of clockwise and counterclockwise The twist-in is divided into light and heavy twist. In many cases, it is the organic combination of shaking, twisting and entering and exiting that can be accomplished; the combination of instruments such as incisional knife, lithotomy balloon and catheter can be used to increase the strength of the guidewire and change its direction. Minimally invasive surgery department of the Second Hospital of Hebei Medical University, Hou Lin Lin Application of catheterization: selective insertion of bile ducts or selective insertion of pancreatic ducts, especially those with papillary lesions or diverticula, intra-diverticular papillae and parapapapillae, can apply the white loach guidewire produced by COOK, using the characteristics of elastic front end of the guidewire, no tissue damage and very smooth when wet, and extending the front end of the catheter by 1~2mm. In some patients, the pancreatic duct is repeatedly visualized but the bile duct is not, so the guidewire can be placed in the pancreatic duct to better expose and fix the papilla, improve the direction of the bile duct, and make it easier to choose the direction of the bile duct. Application when inserting the bile duct or pancreatic duct over the deep part of the stenosis: patients with high bile duct obstruction or pancreatic duct obstruction cross the stenosis into the deep intubation, or selectively enter the left hepatic duct or right hepatic duct with difficulty, at this time, various maneuvers are applied for direct insertion, and failure can be combined with the application of lithotripsy balloon, incision knife (especially the rotatable directional incision knife made by BOSTON), and catheter to change the direction, or can be replaced with COOK’s white loach superslip guidewire. EST application: application of the guide wire deep inside the bile duct can reduce the dislodgement of the incision knife and can avoid accidental incision of the pancreatic duct; it can also avoid repeated insertion of the bile duct, thus reducing the operation time and the occurrence of pancreatitis. The guide wire can also be placed in the bile duct first, and the direction of incision of the duodenal papilla can be adjusted with the help of the guide wire while incision is being made. Application during stone extraction: Especially for intrahepatic bile duct stone extraction or pancreatic duct stone extraction, the stone can be removed by first crossing the stone with a guidewire and then placing a balloon or a mesh basket along the guidewire that can cross the guidewire. The use of a mesh basket after a guidewire in the bile duct can reduce the occurrence of stone impaction and allow for smooth placement of the stone into the nasobiliary duct through the guidewire. Stenosis expansion and stent placement: At this time, the guidewire should be 0.035in, and after crossing the stenosis, the stent should be placed after applying the probe for gradual expansion; for stenosis in the hepatoportal area, sometimes multiple stents need to be placed, the FUSION system can be used, or two guidewires can be placed first to different bile ducts, and one stent can be placed first, and then one guidewire can be entered before placing the stent There are always two guidewires The placement of multiple stents can be done in the bile duct; double stent placement can also be done by placing a stent first and then another guidewire before entering the stent. The guidewire is the “lifeline” of difficult ERCP and plays an important role as a common endoscopic instrument. This study suggests that the flexible application of guidewire improves the success rate, reduces the occurrence of complications and shortens the operation time. 1. The front end of the guidewire is flexible, non-damaging and very smooth when wet. It can explore the lumen of the bile duct or pancreatic duct to enter the bile duct or pancreatic duct, pass through the obstruction or stenosis, and guide the attachment through to improve the success rate. Contrast is the basis of successful diagnosis and treatment. During contrast, the guide wire can be applied to feel into the target duct. By placing the catheter at the papillary opening, the guidewire can be entered in the direction of the 11 o’clock to guide access to the bile duct. When deep intubation is also applied, the advantages of smooth and soft front end of the guidewire, etc. are used to enter using light twisting, heavy twisting, appropriate advancing and shaking techniques, and sometimes it is necessary to combine with instruments such as balloon, incision knife and contrast tube to change the direction of guidewire travel into the target bile duct. When used in conjunction with other instruments, attention should be paid to adjusting the distance between the guidewire and the catheter, the tension of the incisional knife wire, and the different insertion depths of the balloon, so that the guidewire enters the target bile duct directly, or an additional section of the guidewire can be inserted to make it rebound and fold into a circle or hook to enter the target bile duct, and the entry of the guidewire into the target bile duct is the key to a smooth operation and to achieve the expected diagnostic and therapeutic effect. The success rate of the guidewire group is significantly higher than that of the conventional group through the guidewire. 2.The use of guide wire for the exchange of various instruments makes the operation more accurate and safer. Flexible application of the guidewire will shorten the operation time, the direct application of smart knife with guidewire during imaging can determine whether to make an incision after imaging according to the need, and if incision is needed to insert the guidewire into the bile duct, the incision knife will not be easy to slip out of the bile duct, saving the operation time; if treatment is still needed after incision, the guidewire can be inserted deeply into the bile duct or pancreatic duct again to exit the incision knife and exchange for the corresponding instruments again, such as: according to the condition This can reduce the time wasted in repeatedly searching for the target bile duct or pancreatic duct. It is important not to dislodge the guidewire during the operation, as sometimes it is difficult to re-enter the original duct. In the case of tumors in the hilar region that require double or multiple stenting, double guidewires can be used to complete the procedure, and the flexible and successful application of guidewires can significantly improve the efficiency. This group showed that the operation time was shortened by about 9 minutes on average. 3. The steel wire behind the front end of the guidewire can be used to increase the insertion strength of the guidewire and thus guide the mesh basket and stent into the target position. The steel of the guidewire can also be used to change the direction of the duodenal papilla, thus making the contrast and incision smoother, which can reduce the occurrence of complications. When removing intrahepatic bile duct stones is to enter the guide wire into the target bile duct after entering the extraction balloon or extraction mesh basket along the guide wire to remove the stones, and also whether the guide wire can be placed into the target bile duct before placing the stent is also the key to success, without the steel effect of the guide wire, such work cannot be done. The papilla is deviated because of diverticulum, surgery, tumor and other factors; the papilla protrudes too soft and easy to move; it is difficult to intubate in the direction of 11 points; the contrast tube just repeatedly enters the pancreatic duct when the guide wire left in the pancreatic duct can control the papilla in the center of the field of view, the movability of the papilla is suppressed and the intubation in the direction of the bile duct becomes easy, at the same time, the light pressure of the guide wire left downward can make the septum between the bile duct and the pancreatic duct to the side of the pancreatic duct The opening of the bile duct and pancreatic duct will be slightly separated, and the originally curved pancreaticobiliary duct will be slightly straightened, which will facilitate the deep insertion of the contrast catheter into the bile duct. When performing EST, sometimes the position of the papilla is partial or there is a circular fold of duodenal mucosa above the papilla that cannot be completely cut, the guidewire can be placed inside the bile duct to change the direction of the papilla so as to cut the desired length in the desired direction. The presence of a guidewire in the bile duct will make it easy for the mesh basket and other lithotripsy instruments to enter the bile duct, especially for beginners, the presence of a guidewire in the bile duct will also reduce the chance of stone ingrowth during lithotripsy. 4. The impermeability of the guidewire to X-ray can reduce the application of contrast agent. The most common causes of postoperative pancreatitis and hyperamylasemia are obstructed drainage of pancreatic fluid, high pressure in the pancreatic duct; excessive and rapid injection of contrast medium, overfilling of the pancreatic duct causing high pressure in the duct, damage to the epithelium of the duct wall and alveoli, and the toxic effect of contrast medium and activation of pancreatic enzymes by duodenal contents leading to destruction of the pancreatic duct and parenchyma, resulting in self-digestion. The direction of the pancreatic and biliary ducts can be judged according to the direction of travel of the guidewire, which can significantly reduce the intra-ductal hypertension caused by overfilling of the pancreatic ducts with contrast medium and damage the epithelium and alveoli of the duct wall due to the toxic effect of contrast medium, and at the same time, the apex of the yellow zebra guidewire is extremely soft and hydrophilic, which can cause minimal damage to the wall of the pancreatic ducts and reduce the incidence of postoperative pancreatitis and hyperamylaseemia. The impermeability of the guidewire to X-ray reduces the use of contrast agents. The incidence of biliary ductitis and pancreatitis is reduced.