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Novel guidewire with coiled tip improves technical success of guidewire manipulation during EUS-guided biliary drainage (with video)


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

Date of Submission20-Jun-2021
Date of Acceptance30-Nov-2021
Date of Web Publication02-May-2022

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

DOI: 10.4103/EUS-D-21-00148



How to cite this URL:
Ogura T, Okuda A, Ueno S, Nishioka N, Higuchi K. Novel guidewire with coiled tip improves technical success of guidewire manipulation during EUS-guided biliary drainage (with video). Endosc Ultrasound [Epub ahead of print] [cited 2022 Sep 24]. Available from: http://www.eusjournal.com/preprintarticle.asp?id=344248

Guidewire insertion and manipulation is a challenging step during EUS-guided biliary drainage.[1] This could be due to guidewire stack by a fine needle.[2] Various efforts to improve the technical success of guidewire manipulation have been reported,[3],[4],[5] although these techniques might be difficult in nonexpert hands. Due to these issues, a novel 0.025-inch guidewire (INAZUMA, Kaneka Medical Corp., Osaka, Japan) has become available in Japan [Figure 1]. The tip of this guidewire is formed by coiling with 70 mm length, which prevents stack by fine needle [Video 1 [Additional file 1]]. We herein describe technical steps for EUS-guided hepaticogastrostomy using this novel guidewire.
Figure 1: The novel 0.025-inch guidewire (Inazuma, Kaneka Medical Corp., Osaka, Japan). The tip of this guidewire is formed by coiling with 70 mm length

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The intrahepatic bile duct was punctured using a 19G needle (EZ shot; Olympus Medical Systems, Tokyo, Japan), and contrast medium was injected [Figure 2]. Next, the novel guidewire was inserted into the intrahepatic bile duct. However, in cases in which guidewire advancement toward the hepatic hilum is difficult, guidewire torqueing is needed, at which time the guidewire might get stuck. However, since the tip of the novel guidewire is coiled, the guidewire could be advanced into the hepatic hilum without it sticking [Figure 3]. Tract dilation was performed using an ultratapered mechanical dilator (EZ dilator; Zeon Medical, Tokyo, Japan) [Figure 4]. Then, the stent delivery system was inserted into the biliary tract (BileRush Advance, 8 mm × 12 cm, Piolax Medical, Kanagawa, Japan), and stent deployment was subsequently performed from the intrahepatic bile duct to the stomach without any adverse events [Figure 5].
Figure 2: The intrahepatic bile duct was punctured using a 19G needle, and contrast medium was injected to obtain a cholangiogram

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Figure 3: The novel guidewire was inserted into the biliary tract without sticking off the guidewire

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Figure 4: Tract dilation was performed using an ultratapered mechanical dilator

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Figure 5: Stent deployment from the intrahepatic bile duct to the stomach was performed

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In conclusion, the presented novel guidewire might be useful for guidewire insertion or manipulation during EUS-guided biliary drainage, although additional cases and prospective studies are needed to confirm our observations.

Financial support and sponsorship

Nil.

Conflicts of interest

Takeshi Ogura is an Editorial Board Member of the journal. The article was subject to the journal's standard procedures, with peer review handled independently of this editor and his research groups.

 
  References Top

1.
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. 1
    
2.
Ogura T, Higuchi K. Endoscopic ultrasound-guided hepaticogastrostomy: Technical review and tips to prevent adverse events. Gut Liver 2021;15:196-205.  Back to cited text no. 2
    
3.
Nishiguchi K, Ogura T, Nishioka N, et al. Clinical evaluation of physician-controlled guidewire manipulation during endoscopic ultrasound-guided hepaticogastrostomy (with video). Endosc Int Open 2021;9:E395-400.  Back to cited text no. 3
    
4.
Ogura T, Masuda D, Takeuchi T, et al. Liver impaction technique to prevent shearing of the guidewire during endoscopic ultrasound-guided hepaticogastrostomy. Endoscopy 2015;47:E583-4.  Back to cited text no. 4
    
5.
Ryou M, Benias PC, Kumbhari V. Initial clinical experience of a steerable access device for EUS-guided biliary drainage. Gastrointest Endosc 2020;91:178-84.  Back to cited text no. 5
    


    Figures

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



 

 
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