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One-step puncture and dilation with fine-gauge electrocautery dilator for endoscopic ultrasound-guided gallbladder drainage
Recently the usefulness of a novel fine-gauge electrocautery dilator (Fine 025; Medico’s Hirata Inc., Osaka, Japan) ([Fig. 1]) has been reported for endoscopic ultrasound (EUS)-guided therapy   . Herein we describe a successful one-step puncture and tract dilation using this dilator during EUS-guided gallbladder drainage (EUS-GBD).
An 83-year-old woman was admitted to our hospital with recurrent gallstone cholecystitis. Considering her performance status, we decided to perform EUS-GBD.
The gallbladder was visualized using an echoendoscope from the duodenum. A shorter procedure time and fewer device exchanges may be required to reduce bile leakage; however, one-step devices, such as the Hot AXIOS (Boston Scientific, Marlborough, MA), are not yet available for EUS-GBD in Japan. Therefore, we attempted to puncture the gallbladder and dilate the tract in one step using a fine-gauge electrocautery dilator (Fine 025) with a preloaded 0.025-inch guidewire (VisiGlide 2; Olympus Medical Systems, Tokyo, Japan).
The gallbladder was successfully punctured with an electrocautery dilator ([Fig. 2]), and subsequent injection of contrast medium was possible under guidewire loading ([Fig. 3]). After the guidewire was inserted and coiled into the gallbladder under fluoroscopic guidance, the dilator was removed. A fully covered metal stent (diameter, 10 mm; length, 6 cm) (BONA stent; Standard SciTech Inc., Seoul, Korea) was successfully placed without additional tract dilation from the gallbladder into the duodenum. Finally, a 7-Fr double-pigtail plastic stent (length, 10 cm) (Mediglobe GmbH, Rosenheim, Germany) was passed from the gallbladder to the duodenum through the metal stent to prevent stent migration and food impaction ([Fig. 4, ] [Video 1]).
Video 1 Puncture and tract dilation in one step using a fine-gauge electrocautery dilator during endoscopic ultrasound-guided gallbladder drainage.
Our experience with this case suggests that puncture and tract dilation in one step using a fine-gauge electrocautery dilator is an option for EUS-GBD. Further studies involving many cases are needed to validate the safety and efficacy of this one-step procedure.
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11 September 2020 (online)
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- 1 Ogura T, Nakai Y, Iwashita T. et al. Novel fine gauge electrocautery dilator for endoscopic ultrasound-guided biliary drainage: experimental and clinical evaluation study (with video). Endosc Int Open 2019; 7: E1652-E1657
- 2 Mandai K, Uno K, Yasuda K. Endoscopic ultrasound-guided pancreatic duct drainage using a novel fine-gauge electrocautery dilator. Endoscopy 2019; 51: E388-E389
- 3 Ogura T, Nishioka N, Yamada M. et al. Technical feasibility and safety of transluminal antegrade dilation for hepaticojejunostomy stricture using a novel fine-gauge electrocautery dilator (with video). Endosc Int Open 2020; 8: E733-E737