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. 2022 Oct;29(10):e88-e90.
doi: 10.1002/jhbp.904. Epub 2021 Feb 14.

EUS-guided hepaticogastrostomy for hepaticojejunostomy stricture using a 22G needle and a mechanical dilator (with video)

Takeshi Ogura  1 , Saori Ueno  1 , Atsushi Okuda  1 , Nobu Nishioka  1 , Kazuhide Higuchi  1
Affiliations

EUS-guided hepaticogastrostomy for hepaticojejunostomy stricture using a 22G needle and a mechanical dilator (with video)

Takeshi Ogura et al. J Hepatobiliary Pancreat Sci. 2022 Oct.

Abstract

EUS-guided biliary drainage (EUS-BD) has been indicated for benign biliary strictures. However, the intrahepatic bile duct is sometimes much narrower in benign biliary strictures. In this situation, puncture of the intrahepatic bile duct using a 19-G needle is sometimes challenging. Several reports have described attempts at EUS-BD using a 22-G needle, but fistula dilation with a 22-G needle is challenging because the 0.018-inch guidewire is not stiff enough to perform dilatation. Recently, a thin mechanical dilator has become available. After its insertion into the biliary tract, the 0.018-inch guidewire can be replaced with a 0.025-inch guidewire. We herein describe the technical procedure of EUS-guided hepaticogastrostomy using a 22-G needle with a thin mechanical dilator.

Keywords: ERCP; EUS; EUS-guided biliary drainage; EUS-guided hepaticogastrostomy; hepaticojejunostomy stricture.

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