• Users Online:235
  • Home
  • Print this page
  • Email this page
Home About us Editorial board Search Ahead of print Current issue Archives Submit article Instructions Subscribe Contacts Login 

 
IMAGES AND VIDEOS
Ahead of print publication  

EUS-guided hepaticojejunostomy using a 22G needle and novel 0.018-inch guidewire (with video)


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

Date of Submission17-Aug-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
Login to access the Email id

Source of Support: None, Conflict of Interest: None

DOI: 10.4103/EUS-D-21-00184



How to cite this URL:
Ogura T, Okuda A, Ueno S, Nishioka N, Higuchi K. EUS-guided hepaticojejunostomy using a 22G needle and novel 0.018-inch guidewire (with video). Endosc Ultrasound [Epub ahead of print] [cited 2022 Sep 24]. Available from: http://www.eusjournal.com/preprintarticle.asp?id=344253

EUS-guided hepaticojejunostomy (EUS-HJS) is usually indicated for malignant biliary obstruction with surgical altered anatomy such as Roux-en Y anastomosis.[1] However, because of the limited flexibility of up-angulation of the echoendoscope in the intestine, which is more confined compared with the stomach, EUS-HJS can be challenging. EUS-guided biliary drainage has recently been attempted in patients with malignant biliary obstruction and also in those with benign biliary disease.[2],[3] Bile duct puncture may be difficult in such cases due to constriction of the intrahepatic bile duct. Therefore, EUS-HJS for patients with benign biliary disease and Roux-en Y anastomosis is extremely challenging. Use of a 22G needle enables easy puncture of the bile duct, but guidewire insertion can be challenging because it requires manipulation of a conventional guidewire that is not smooth. A novel stiff 0.018-inch guidewire has recently become available in Japan (Fielder; Olympus, Tokyo, Japan) [Figure 1]. The guidewire has a coiled tip that prevents the guidewire sticking to the fine needle aspiration needle, which is common when using conventional 0.018-inch guidewires. Here, we described technical tips for EUS-HJS using a 22G needle with the novel 0.018-inch guidewire.
Figure 1: The novel 0.018-inch guidewire (Fielder, Olympus, Tokyo, Japan)

Click here to view


The intrahepatic bile duct was punctured using a 22G needle (EZ shot; Olympus Medical Systems, Tokyo, Japan), and contrast medium was injected [Figure 2]. The novel guidewire was then inserted into the intrahepatic bile duct. The coiled tip enabled the guidewire to be advanced into the common bile duct without sticking [Figure 3]. After tract dilation using an ultra-tapered mechanical dilator (EZ dilator; Zeon Medical, Tokyo, Japan) [Figure 4], a plastic stent was deployed from the intrahepatic bile duct to the jejunum without any adverse events [Figure 5] & [Video 1 [Additional file 1]].
Figure 2: The intrahepatic bile duct is punctured using a 22G needle and contrast medium was injected to obtain a cholangiogram

Click here to view
Figure 3: The novel guidewire is inserted into the common bile duct without sticking of the guidewire

Click here to view
Figure 4: Tract dilation is performed using an ultra-tapered mechanical dilator

Click here to view
Figure 5: Stent deployment from the intrahepatic bile duct to the jejunum is performed

Click here to view


In conclusion, a novel stiff 0.018-inch guidewire might be useful for guidewire insertion or manipulation during EUS-guided biliary drainage.

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.
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. 1
    
2.
Mukai S, Tsuchiya T, Itoi T. Interventional endoscopic ultrasonography for benign biliary diseases in patients with surgically altered anatomy. Curr Opin Gastroenterol 2019;35:408-15.  Back to cited text no. 2
    
3.
Ogura T, Nishioka N, Yamada M, Yamada T, Ueno S, Matsuno J, et al. Novel transluminal treatment protocol for hepaticojejunostomy stricture using covered self-expandable metal stent. Surg Endosc 2021;35:209-15.  Back to cited text no. 3
    


    Figures

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



 

 
Top
 
 
  Search
 
     Search Pubmed for
 
    -  Ogura T
    -  Okuda A
    -  Ueno S
    -  Nishioka N
    -  Higuchi K
    Access Statistics
    Email Alert *
    Add to My List *
* Registration required (free)  

 
  In this article
   References
   Article Figures

 Article Access Statistics
    Viewed603    
    PDF Downloaded9    

Recommend this journal