The utility of 22-gauge needle for endoscopic ultrasonography-guided hepaticogastrostomy
(EUS-HGS) has been reported; however, a dedicated guidewire has not been developed
[1]
[2]
[3]
[4]
[5]. Recently, a novel 0.018-inch guidewire (J-wire NM; J-MIT) without markers was developed
to prevent guidewire stacking and a stiff shaft for smooth stent delivery. Additionally,
a 7-Fr slim-delivery metallic stent (Niti-S EUS-BD system End Bare Single Flare; Taewoong
Medical Co., Ltd.) has an ultra-tapered tip designed to minimize the gap with a 0.018-inch
guidewire ([Fig. 1]). Herein, we report a case in which EUS-HGS was successfully performed using a novel
0.018-inch guidewire and slim-delivery metallic stent ([Video 1]).
Fig. 1
a A novel 0.018-inch guidewire (J-wire NM; J-MIT) without
markers was developed for endoscopic ultrasound-guided hepaticogastrostomy to prevent
guidewire stacking at the needle tip. b Novel self-expandable
metallic stent with a 7-Fr slim-delivery system (Niti-S EUS-BD system End Bare Single
Flare;
Taewoong Medical Co., Ltd.) features an ultra-tapered tip that minimizes the gap with
a
0.018-inch guidewire.
A novel 0.018-inch guidewire without markers and a 7-Fr slim-delivery metallic stent
were useful for endoscopic ultrasonography-guided hepaticogastrostomy.Video 1
A 64-year-old man who had previously undergone distal gastrectomy with Roux-en Y reconstruction
for advanced gastric cancer was admitted to our hospital due to obstructive jaundice
caused by a recurrent tumor ([Fig. 2]). As balloon enteroscopy could not reach the papilla of Vater due to tumor infiltration
([Fig. 3]), EUS-HGS was attempted. The slightly dilated B3 was punctured using a 22-gauge
needle (Expect Slim-line; Boston Scientific Co.) ([Fig. 4]). After the cholangiography, the novel 0.018-inch guidewire migrated outside of
the bile duct; however, it was safely removed without guidewire stacking. After re-puncture,
the guidewire was successfully inserted into the bile duct. Subsequently, tract dilation
was performed using a 7-Fr bougie dilator dedicated to a 0.018-inch guidewire (ES
Dilator Soft; Zeon Medical, Inc.). To minimize the risk of bile leakage, the novel
metallic stent (8-mm, 12-cm) with a 7-Fr slim delivery system was inserted without
guidewire exchange. The metallic stent was successfully placed from the bile duct
to the stomach. The patient was discharged without adverse events following the improvement
of jaundice.
Fig. 2 Computed tomography images show huge lymph node metastases (arrowheads) that obstruct
the common bile duct and the duodenum. a Axis plane. b Coronal plane.
Fig. 3 Balloon enteroscopy reveals tumor infiltration at the duodenum that prevent to reach
the
papilla of Vater. a Endoscopic image. b
Fluoroscopic image.
Fig. 4 Endoscopic ultrasonography-guided hepatogastrostomy. a The
slightly dilated bile duct is shown at segment 3. b Although the
novel 0.018-inch guidewire migrates outside the bile duct, it can be removed without
guidewire stacking. c After the guidewire insertion into the bile
duct, a 7-Fr slim delivery of a novel metallic stent (Niti-S EUS-BD system End Bare
Single
Flare; Taewoong Medical Co., Ltd.) is inserted along the guidewire. d The metallic stent is successfully placed from the bile duct to the
stomach.
To the best of our knowledge, this is the first report of EUS-HGS using a novel 0.018-inch
guidewire and an ultra-tapered, slim-delivery metallic stent.
Endoscopy_UCTN_Code_TTT_1AS_2AH
E-Videos is an open access online section of the journal Endoscopy, reporting on interesting cases and new techniques in gastroenterological endoscopy.
All papers include a high-quality video and are published with a Creative Commons
CC-BY license. Endoscopy E-Videos qualify for HINARI discounts and waivers and eligibility is automatically checked during the submission
process. We grant 100% waivers to articles whose corresponding authors are based in
Group A countries and 50% waivers to those who are based in Group B countries as classified
by Research4Life (see: https://www.research4life.org/access/eligibility/).
This section has its own submission website at https://mc.manuscriptcentral.com/e-videos.
