Endoscopic ultrasound-guided hepaticogastrostomy without tract dilation using a novel 0.035-inch guidewire

Biliary peritonitis is one of the complications of endoscopic ultrasound-guided hepaticogastrostomy (EUS-HGS), and it is mostly caused by tract dilation [1] [2] [3]. In patients with acute cholangitis, bile leakage may cause refractory infection in the abdominal cavity. Therefore, omitting tract dilation is expected to reduce the risk of bile peritonitis; however, plastic stent placement without tract dilation has been reported as challenging [4]. A novel 0.035-inch guidewire (CAPELLA 0.035; Japan Lifeline Co., Ltd., Tokyo, Japan) has a stiff shaft that facilitates stent deployment in EUS-HGS ([Fig. 1]), which is also compatible with most devices designed for 0.025-inch guidewires. Herein, we present two cases in which a plastic stent was successfully placed without tract dilation using a CAPELLA 0.035 during EUS-HGS ([Video 1]).

Fig. 1 A novel 0.035-inch guidewire (CAPELLA 0.035) has a stiff shaft that facilitates stent deployment in endoscopic ultrasound-guided hepaticogastrostomy, and it is also available with most devices dedicated to 0.025-inch guidewires.

A novel guidewire, CAPELLA 0.035-inch, has a soft and tapered tip that facilitates plastic stent placement without tract dilation during endoscopic ultrasound-guided hepaticogastrostomy.Video 1

Case 1: A 78-year-old man with acute cholangitis caused by biliary stricture of the lateral branch was admitted. EUS-HGS was performed because transpapillary drainage failed. Firstly, B2 was punctured with a 19-gauge needle, and a 0.025-inch guidewire (VisiGlide 2; Olympus Medical Systems, Tokyo, Japan) was inserted after contrast injection. Subsequently, an ultra-tapered catheter (MTW Endoskopie Manufaktur, Wesel, Germany) was advanced, and the guidewire was exchanged for a CAPELLA 0.035. Finally, a 7-Fr plastic stent (Through and Pass Type IT; Gadelius Medical, Tokyo, Japan) was successfully placed ([Fig. 2]).

Fig. 2 Case 1. a B2 was punctured with a 19-gauge needle, followed by contrast injection and insertion of a 0.025-inch guidewire. b An ultra-tapered catheter was inserted into the bile duct, and the guidewire was exchanged for a CAPELLA 0.035. c A 7-Fr plastic stent was successfully placed without tract dilation.

Case 2: An 82-year-old woman with a hepaticojejunostomy anastomotic stricture due to recurrence of ampullary carcinoma was admitted with acute cholangitis. EUS-HGS was performed for acute cholangitis caused by the recurrence of a biliary obstruction after plastic stent placement. B2 was punctured with a 19-gauge needle and a 0.025-inch guidewire was placed in the right hepatic duct. After the guidewire exchange for a CAPELLA 0.035, the plastic stent was successfully placed ([Fig. 3]).

Fig. 3 Case 2. a B2 was punctured with a 19-gauge needle, followed by contrast injection and insertion of a 0.025-inch guidewire. b After exchanging the guidewire for a CAPELLA 0.035, a catheter was inserted into the right hepatic duct. c A 7-Fr plastic stent is successfully placed without tract dilation.

To the best of our knowledge, this is the first report of EUS-HGS omitting tract dilation enabled by a novel 0.035-inch guidewire that is essential for this procedure.

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Conflict of Interest

The authors declare that they have no conflict of interest.

• References

• 1 Ogura T, Higuchi K. Endoscopic ultrasound-guided hepaticogastrostomy: Technical review and tips to prevent adverse events. Gut Liver 2021; 15: 196-205
• 2 Mukai S, Itoi T, Tsuchiya T. et al. One-step tract dilation using a novel long balloon catheter during endoscopic ultrasound-guided hepaticogastrostomy. J Hepatobiliary Pancreat Sci 2024; 31: e38-e40
• 3 Yamamoto Y, Ogura T, Nishioka N. et al. Risk factors for adverse events associated with bile leak during EUS-guided hepaticogastrostomy. Endosc Ultrasound 2020; 9: 110-115
• 4 Ohno A, Fujimori N, Kaku T. et al. Feasibility and efficacy of endoscopic ultrasound-guided hepaticogastrostomy without dilation: A propensity score matching analysis. Dig Dis Sci 2022; 67: 5676-5684

Publication History

Article published online:
20 February 2025