For performance of endoscopic ultrasound-guided biliary drainage (EUS-BD), such as
with EUS-guided hepaticogastrostomy (EUS-HG) [1]
[2], the fistula must be dilated so that the stent delivery system can be inserted [3]. We demonstrate herein a simplified technique for performing EUS-BD with a novel
fine-gauge balloon catheter (REN Biliary Dilation Catheter; Kaneka Corporation, Osaka,
Japan).
This balloon catheter is designed for use coaxially with a 0.025-inch guidewire ([Fig. 1]), having a lumen through which the guidewire can be advanced. In addition the catheter
tip is only 3 Fr in diameter and is tapered. For an EUS-BD procedure, the dilation
device must have a fine gauge and adequate stiffness to dilate the fistula. After
the bile duct has been punctured with a 19-gauge aspiration needle, this balloon catheter
can easily be inserted without any dilation devices. Therefore, the risk for bile
leakage from the fistula may be decreased because no device exchange is needed and
the procedure time is reduced.
Fig. 1 The tip of the balloon catheter is only 3 Fr in diameter, tapered, and coaxial with
the 0.025-in guidewire.
A 77-year-old woman admitted for obstructive jaundice due to pancreatic cancer underwent
distal gastric resection with a Roux-en-Y procedure. EUS-HG was selected as the biliary
drainage method. First, we punctured the left intrahepatic bile duct with a 19-gauge
aspiration needle ([Fig. 2 a]) and injected contrast medium. The lower biliary duct was obstructed. Then, we inserted
the stiff 0.025-inch guidewire ([Fig. 2 b]). After the guidewire had been inserted into the intestine, the novel balloon catheter
was easily and smoothly inserted into the intestine across the stricture site and
used to dilate the intrahepatic bile duct and stomach wall ([Fig. 2 c]). A metallic stent was placed in antegrade fashion ([Fig. 2 d]). Finally, EUS-HG was performed ([Fig. 3], [Video 1]). No adverse events occurred, and the procedure time was only 21 minutes.
Fig. 2 In a 77-year-old woman with obstructive jaundice due to pancreatic cancer, hepaticogastrostomy
is selected as the biliary drainage method. a The intrahepatic bile duct is punctured with a 19-gauge aspiration needle. b The guidewire is inserted into the biliary tract. c The stomach wall is dilated with the novel balloon catheter. d A fully covered metallic stent is placed in antegrade fashion.
Fig. 3 Endoscopic ultrasound-guided hepaticogastrostomy is completed.
The intrahepatic bile duct is punctured with a 19-gauge aspiration needle, and contrast
medium is injected. The guidewire is inserted, and then the novel balloon catheter
is easily inserted. After balloon dilation, antegrade stent placement is performed.
Finally, endoscopic ultrasound-guided hepaticogastrostomy is completed.
This novel balloon catheter facilitates fistula dilation in EUS-BD procedures, and
the procedure time may be reduced.
Endoscopy_UCTN_Code_TTT_1AT_2AB
