A novel technique of intraductal ultrasonography using a newly designed endoscopic sheath and Y-connector during endoscopic retrograde cholangiography

Intraductal ultrasonography (IDUS) is a useful diagnostic modality for the detection of biliary stones [1]. However, conventional IDUS cannot provide accurate cross-sectional imaging of the bile duct in patients with pneumobilia. To overcome this limitation, we describe a novel IDUS technique using a newly designed endoscopic sheath and Y-connector to confirm complete biliary stone removal.

A 78-year-old woman was referred to our hospital due to acute cholangitis caused by biliary stones. Endoscopic sphincterotomy and transpapillary biliary drainage were performed. Four days later, biliary stone removal was performed using a basket catheter, and IDUS using a newly designed endoscopic sheath and Y-connector was carried out to confirm complete extraction. First, an endoscopic sheath (outer and inner diameters 2.4 mm and 2.06 mm, respectively; Endosheather; Piolax Medical Devices, Kanagawa, Japan) was inserted over the guidewire. The inner catheter and guidewire were removed, and the outer sheath was left in place. After a Y-connector with a 10-Fr internal lumen (Okay II; Goodman, Aichi, Japan) was attached to the proximal end of the outer sheath, a 1.8-mm-diameter ultra-slim radial ultrasonic probe (UM-S20-17S; Olympus Medical Systems, Tokyo, Japan) was inserted through the Y-connector and outer sheath ([Fig. 1]). Fluoroscopy and IDUS confirmed that the probe tip emerged slightly from the tip of the outer sheath, and then the valve of the Y-connector was closed to fix the probe. IDUS was performed while the outer sheath was withdrawn along with the probe. During IDUS, air bubbles were aspirated and saline-diluted contrast medium was injected through the sideport as needed ([Fig. 2]). The inside of the bile duct could be clearly observed and complete stone removal was confirmed ([Video 1]).

Fig. 1 a The tip of the ultra-slim ultrasonic probe emerges from the tip of the outer sheath (blue arrow) of the Endosheather. b The Y-connector with a 10-Fr internal lumen is attached to the proximal end of the outer sheath (red arrow). The ultra-slim ultrasonic probe (yellow arrow) is inserted through the Y-connector and outer sheath.

Fig. 2 a The inside of the bile duct cannot be observed due to air bubbles. b After air bubbles are aspirated and saline-diluted contrast medium diluted is injected through the Endosheather, the inside of the bile duct can be clearly observed.

Video 1 Endoscopic sheath-assisted intraductal ultrasonography to confirm complete removal of biliary stones.

This case suggests that this novel IDUS technique using a newly designed endoscopic sheath and Y-connector is promising for bile duct evaluation in patients with pneumobilia.

Endoscopy_UCTN_Code_TTT_1AS_2AD

 

MissingLinkText

Competing interests

The authors declare that they have no conflict of interest.

• Reference

• 1 Kim DC, Moon JH, Choi HJ. et al. Usefulness of intraductal ultrasonography in icteric patients with highly suspected choledocholithiasis showing normal endoscopic retrograde cholangiopancreatography. Dig Dis Sci 2014; 59: 1902-1908

Publication History

Article published online:
28 October 2022