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Multicenter Study
. 2022 Jul;29(7):810-816.
doi: 10.1002/jhbp.1021. Epub 2021 Aug 11.

Utility of dedicated bougie dilator for a 0.018-inch guidewire during EUS-guided biliary drainage: A multi-center retrospective cohort study

Takuji Iwashita  1 , Takeshi Ogura  2 , Hirotoshi Ishiwatari  3 , Yousuke Nakai  4   5 , Keisuke Iwata  6 , Tsuyoshi Mukai  7 , Masahito Shimizu  1 , Hiroyuki Isayama  8 , Ichiro Yasuda  9 , Takao Itoi  10
Affiliations
Multicenter Study

Utility of dedicated bougie dilator for a 0.018-inch guidewire during EUS-guided biliary drainage: A multi-center retrospective cohort study

Takuji Iwashita et al. J Hepatobiliary Pancreat Sci. 2022 Jul.

Abstract

Background: During endoscopic ultrasound-guided biliary drainage (EUS-BD), a combination of a 19-gauge needle and a 0.025-inch guidewire is generally used. However, a 19-gauge needle has poor maneuverability because of their stiffness and rigidity and might have poor penetrability in non-dilated bile ducts because of their large bore. In contrast, the application of a 22-gauge needle is expected to have improved maneuverability. However, only a 0.018-inch guidewire, which has less supportability, is applicable in the subsequent guidewire selection. This study aimed to evaluate the feasibility and safety of a dedicated bougie dilator for a 0.018-inch guidewire.

Methods: From September 2019 to May 2020, 26 patients underwent fistula dilation using the dilator after accessing the bile duct using a 22-gauge needle and a 0.018-inch guidewire during EUS-BD. The success and adverse event rates of EUS-BD were evaluated.

Results: Biliary access with a combination of a 22-gauge needle and a 0.018-inch guidewire was successful in all with a median bile duct diameter of 5 mm. Dilation of the fistula using the dedicated dilator was also successful in all cases. Subsequently, the dilator was successfully exchanged to an ERCP catheter that allowed for exchange to a 0.025-inch guidewire, except in one case where the catheter did not cross the fistula and a dilation balloon was inserted for an exchange to a 0.025-inch guidewire. The technical success rate of the EUS-BD was 100%. The adverse event rate was 19%.

Conclusion: The application of the dedicated dilator for a 0.018-inch guidewire was considered feasible and safe for EUS-BD.

Keywords: 22-gauge; antegrade treatment; endoscopic ultrasound; hepaticogastrostomy; tapered.

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References

REFERENCES

    1. Giovannini M, Moutardier V, Pesenti C, Bories E, Lelong B, Delpero JR. Endoscopic ultrasound-guided bilioduodenal anastomosis: a new technique for biliary drainage. Endoscopy. 2001;33:898-900.
    1. Iwashita T, Doi S, Yasuda I. Endoscopic ultrasound-guided biliary drainage: a review. Clin J Gastroenterol. 2014;7:94-102.
    1. Kongkam P, Tasneem AA, Rerknimitr R. Combination of endoscopic retrograde cholangiopancreatography and endoscopic ultrasonography-guided biliary drainage in malignant hilar biliary obstruction. Dig Endosc. 2019;31(Suppl 1):50-4.
    1. Irisawa A, Miyoshi H, Itoi T, Ryozawa S, Kida M, Inui K. Recent innovations in therapeutic endoscopy for pancreatobiliary diseases. Dig Endosc. 2020;32:309-15.
    1. Paik WH, Lee TH, Park DH, Choi JH, Kim SO, Jang S, et al. EUS-guided biliary drainage versus ERCP for the primary palliation of malignant biliary obstruction: a multicenter randomized clinical trial. Am J Gastroenterol. 2018;113:987-97.

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