Electrochemical in-situ intraoperative testing during ERCP for safer cannulation: A Novel Approach Using Multi-Pole Electrodes and Electrochemical Impedance Spectroscopy

Aims Inadvertent pancreatic duct cannulation is a common unwanted event during ERCP procedures that may increase the rates of complications. This study introduces a novel method for guiding ERCP navigation by employing multi-polar electrodes to measure the electrical properties of bile and pancreatic juices through Electrochemical Impedance Spectroscopy (EIS). The method is intended for use during ERCP to alert the user about pancreatic duct proximity and help in directing the position of the sphincterotome for selective biliary canulation

Methods Data from 10 patients were collected in Galilee Medical Center, with 3 excluded due to specific inclusion criteria. The study aimed to obtain at least two juice samples from each patient, including bile juice and either mixed juice from the papilla or pancreatic juice in cases of inadvertent cannulation of the pancreatic duct. Juices were collected based on the Gastroendoscopist’s clinical impression about the probe location and X-ray confirmation for proper positioning before juice collection. Subsequently, electrodes were dipped into the collected juices, and EIS measurements were performed between 100 Hz up to 180 KHz.

Results Overall, 7 patients were included in the final analysis. All patients had biliary juice obtained, 6 patients had mixed papillary juice obtained, and 2 patients had pancreatic juice obtained. The magnitude values of all juices through EIS measurements were examined. Analysis revealed that our multi-pole sensors successfully differentiated between bile and pancreatic/mixed juices. The average Impedance magnitude was 10970.9±4938.8 OHM for biliary juice, 8010.3±1737.3 OHM for mixed papillary juice, and 26662±17738.5 OHM for pancreatic juice (P=0.09 for biliary vs. mixed juice, P=0.02 for biliary vs. pancreatic juice, and P=0.01 for mixed vs. pancreatic juice). Based on these results, a future sensor-based navigation kit will be planned to aim for better selective biliary canulation, thus avoiding unintended canulation of the pancreatic duct.

Conclusions Our study demonstrates the promising potential of this electrochemical navigation method to provide selective and safe biliary cannulation during ERCP procedures. Further research and validation are warranted to establish its clinical applicability and benefits.

Conflicts of interest

Authors do not have any conflict of interest to disclose.

Publication History

Article published online:
15 April 2024