Commentary

Drainage of abdominal collections by endoscopic ultrasound (EUS) carries various advantages when compared to percutaneous drainage, but does require proximity of the target to the gastrointestinal tract. Technical failures are mainly related to: (i) scope access, (ii) needle access, and (iii) the ability to advance endoscopic accessories. Kazuki Hama et al. describe a simple yet resourceful technique, where additional sheath advancement towards the target organ facilitated deeper needle access and successful drainage [1].

Although this technique may provide us with additional reach, readers should however be aware that puncture distance is often inversely related to needle visualization and tip control. Excess sheath usage may furthermore induce CO2 interference by creating space between the mucosa and transducer. And lastly, care should be taken to prevent sheath-related injury to the gastrointestinal tract. Therefore this approach might be useful in selected situations where those additional millimeters of needle length are required.

Publication History

Article published online:
28 January 2025

• Reference

• 1 Hama K, Matsunami Y, Tsuchiya T. et al. Endoscopic ultrasound-guided drainage of bilomas in difficult-to-puncture locations using a sheath-assisted puncture technique. Endoscopy 2024; 56: E874-E875