CC BY 4.0 · Endoscopy 2024; 56(S 01): E726-E727
DOI: 10.1055/a-2374-8711
E-Videos

One-step primary endoscopic ultrasound-guided choledochoduodenostomy without lumen-apposing metal stent using a Franseen needle and an ultra-stiff high-sliding guidewire

1   Department of Gastroenterology, Aichi Medical University, Nagakute, Japan (Ringgold ID: RIN12703)
,
Rena Kitano
1   Department of Gastroenterology, Aichi Medical University, Nagakute, Japan (Ringgold ID: RIN12703)
,
Mayu Ibusuki
1   Department of Gastroenterology, Aichi Medical University, Nagakute, Japan (Ringgold ID: RIN12703)
,
Tomoya Kitada
1   Department of Gastroenterology, Aichi Medical University, Nagakute, Japan (Ringgold ID: RIN12703)
,
Kazumasa Sakamoto
1   Department of Gastroenterology, Aichi Medical University, Nagakute, Japan (Ringgold ID: RIN12703)
,
Jun Arai
1   Department of Gastroenterology, Aichi Medical University, Nagakute, Japan (Ringgold ID: RIN12703)
,
Kiyoaki Ito
1   Department of Gastroenterology, Aichi Medical University, Nagakute, Japan (Ringgold ID: RIN12703)
› Author Affiliations

Endoscopic ultrasound-guided choledochoduodenostomy (EUS-CDS) using a lumen-apposing metal stent (LAMS) can be used as a primary treatment for malignant distal biliary obstruction because of its higher technical success rates and shorter procedure times than conventional transpapillary metal stent placement [1] [2]. However, it is unsuitable for minimally dilated common bile ducts (CBDs) and thin 6-mm-diameter LAMSs are commonly used owing to large flanges. Other disadvantages include high costs, early stent dysfunction, and adverse events caused by biliary wall compression, duodenobiliary reflux, and cautery puncture [3]. Conversely, EUS-CDS with conventional metal stents requires a fistula dilation step that is time-consuming, leading to biliary peritonitis and a high risk of stent migration. Therefore, we propose a novel one-step EUS-CDS method without a LAMS using a Franseen needle and an ultra-stiff, high-sliding guidewire.

The Franseen needle creates a larger-diameter fistula during puncture than standard needles [4] ([Fig. 1]). The 0.035-inch guidewire has a thick, high-rigidity nickel-titanium core and polytetrafluoroethylene coating with “ridge-processing” to minimize the contact area and friction, enhancing device followability and insertability ([Fig. 2]). This combination can eliminate the need for fistula dilation even when inserting a thick delivery system. A dumbbell-shaped metal stent [5] was employed for stenting owing to its antimigration properties.

Zoom Image
Fig. 1 a, c In the bench test, the 19-G Franseen needle (SonoTip TopGain; Medi-Globe, Rohrdorf, Germany) creates a 1.27 mm-diameter hole. b, d In contrast, the 19-G standard needle (SonoTip Pro Control; Medi-Globe) creates a 0.70 mm-diameter hole.
Zoom Image
Fig. 2 The novel guidewire measures 0.035 inches and features a thick, high-rigidity nickel-titanium core. The surface is coated with polytetrafluoroethylene, using “ridge-processing”, which reduces contact area and friction with devices, enhancing followability and insertability.

An 83-year-old man with obstructive jaundice due to malignant distal biliary obstruction was scheduled for primary EUS-CDS drainage. After CBD puncture from the duodenum using a 19-G Franseen needle (SonoTip TopGain; Medi-Globe, Rohrdorf, Germany), an ultra-stiff guidewire (SeekMaster Hard; Piolax Medical Devices, Kanagawa, Japan) was inserted into the intrahepatic bile duct. Subsequently, the 8-Fr delivery system of the dumbbell-shaped stent (BONASTENT M-Intraductal; Standard Sci-Tech Inc., Seoul, Korea) was smoothly inserted without fistula dilation, followed by placement of the stent from the CBD to the duodenum ([Fig. 3], [Video 1]). The procedure was completed within five minutes. No adverse events or stent dysfunction, including biliary peritonitis or migration, occurred until the patient’s death.

Zoom Image
Fig. 3 a A 19-G Franseen needle was used to puncture the common bile duct from the duodenum. b The novel guidewire was inserted into the intrahepatic bile duct. c Subsequently, the 8-Fr delivery system of the dumbbell-shaped metal stent was smoothly inserted without the need for fistula dilation. d The metal stent (12 × 50 mm) was then placed from the common bile duct to the duodenum.

Quality:
One-step primary endoscopic ultrasound-guided choledochoduodenostomy using a Franseen needle and an ultra-stiff, high-sliding guidewireVideo 1

This method offers a straightforward and effective primary drainage approach for malignant distal biliary obstruction, addressing the limitations of EUS-CDS with a LAMS.

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Publication History

Article published online:
08 August 2024

© 2024. The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution License, permitting unrestricted use, distribution, and reproduction so long as the original work is properly cited. (https://creativecommons.org/licenses/by/4.0/).

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