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Jumping technique for guidewire manipulation within an intrahepatic bile duct during EUS-guided biliary drainage (with video)

 2nd Department of Internal Medicine, Osaka Medical College, Osaka, Japan

Date of Submission31-Aug-2020
Date of Acceptance04-Jan-2021
Date of Web Publication21-Apr-2021

Correspondence Address:
Takeshi Ogura,
2nd Department of Internal Medicine, Osaka Medical College, 2-7 Daigakuchou, Takatsukishi, Osaka 569-8686
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Source of Support: None, Conflict of Interest: None

DOI: 10.4103/EUS-D-20-00194

PMID: 33884999

How to cite this URL:
Ogura T, Ueno S, Okuda A, Nishioka N, Higuchi K. Jumping technique for guidewire manipulation within an intrahepatic bile duct during EUS-guided biliary drainage (with video). Endosc Ultrasound [Epub ahead of print] [cited 2021 Jun 21]. Available from: http://www.eusjournal.com/preprintarticle.asp?id=314170

EUS-guided hepaticogastrostomy (EUS-HGS) is a useful biliary drainage technique for patients with an inaccessible papilla.[1],[2],[3],[4] Although high technical success rates have been reported for EUS-HGS, guidewire manipulation is the critical limitation for inexperienced operators.[5] A common cause of failure is insertion of the guidewire into a peripheral intrahepatic bile duct. In this situation, the guidewire should be pulled back, until the tip of the guidewire is turned toward the hepatic hilum. However, this technique can be challenging in the case of an acute angle between the intrahepatic bile duct and the needle. Here, we describe a technical tip for EUS-HGS termed the “jumping technique” for guidewire manipulation.

A 72-year-old male was admitted to our hospital due to frequent cholangitis caused by multiple intrahepatic bile duct stones. He had previously undergone distal gastrectomy due to gastric cancer with Roux-en-Y anastomosis. EUS-HGS was therefore attempted. Because the intrahepatic bile duct stone removal was planned after EUS-HGS, B2 was first selected as puncture site. However, when B2 was visualized, entry route was esophagus. Therefore, B3 was punctured using a 19G needle. Cholangiography revealed multiple intrahepatic bile duct stones [Figure 1]. A 0.025-inch guidewire (VisiGlide; Olympus Medical Systems, Tokyo, Japan) was then inserted into the intrahepatic bile duct; however, the guidewire was advanced into the periphery of the bile duct [Figure 2]. Guidewire manipulation was challenging because the intrahepatic bile duct was less dilated than in malignant biliary obstruction. We inserted the guidewire once more into the periphery of the bile duct and formed the guidewire into a loop [Figure 3]. By gently pulling on the looped guidewire, the guidewire jumped to the hepatic hilum [Figure 4]. Finally, following dilation of the fistula, a plastic stent was deployed without any adverse events [Figure 5] and [video 1] [Additional file 1].
Figure 1: Cholangiography showing multiple intrahepatic bile duct stones

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Figure 2: The guidewire has been advanced into the periphery of the intrahepatic bile duct

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Figure 3: The guidewire is formed into a loop

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Figure 4: The guidewire is gently pulled, causing it to jump to the hepatic hilum

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Figure 5: Successful EUS-guided hepaticogastrostomy using a plastic stent

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The presented technique may be useful during selective guidewire insertion not only for patients with hilar stricture during endoscopic retrograde cholangiopancreatography but also in the case of insufficient biliary dilatation such as in benign biliary disease during EUS-HGS.

Declaration of patient consent

The authors certify that they have obtained all appropriate patient consent forms. In the form the patient has given his consent for his images and other clinical information to be reported in the journal. The patient understands that his name and initials will not be published and due efforts will be made to conceal his identity, but anonymity cannot be guaranteed.

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Conflicts of interest

There are no conflicts of interest.

  References Top

Guo J, Giovannini M, Sahai AV, et al. A multi-institution consensus on how to perform EUS-guided biliary drainage for malignant biliary obstruction. Endosc Ultrasound 2018;7:356-65.  Back to cited text no. 1
Boulay BR, Lo SK. Endoscopic ultrasound-guided biliary drainage. Gastrointest Endosc Clin N Am 2018;28:171-85.  Back to cited text no. 2
Ogura T, Higuchi K. Technical tips for endoscopic ultrasound-guided hepaticogastrostomy. World J Gastroenterol 2016;21:3945-51.  Back to cited text no. 3
Mukai S, Tsuchiya T, Itoi T. Interventioanl endoscopic ultrasonography for bengin biliary disease in patients with surgically altered anatomy. Curr Opin Gastroenterol 2019;35:408-15.  Back to cited text no. 4
Vila JJ, Pérez-Miranda M, Vazquez-Sequeiros E, et al. Initial experience with EUS-guided cholangiopancreatography for biliary and pancreatic duct drainage: a Spanish national survey. Gastrointest Endosc 2012;76:1133-41.  Back to cited text no. 5


  [Figure 1], [Figure 2], [Figure 3], [Figure 4], [Figure 5]


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