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DOI: 10.1055/a-2491-4524
Technique for stretching a bent guidewire with a biopsy forceps in endoscopic ultrasound-guided hepaticogastrostomy
Intraductal manipulation of the guidewire has been reported to be the most challenging step in endoscopic ultrasound-guided hepaticogastrostomy (EUS-HGS) [1]. Guidewire deviation not only results in an unsuccessful procedure, but can also cause bile leakage [2]. We hereby report a case in which the placed guidewire deviated during the EUS-HGS procedure, but we were able to recover it using biopsy forceps ([Video 1]).
A rescue technique using a biopsy forceps to straighten a bent and deviated guidewire is performed during endoscopic ultrasound-guided hepaticogastrostomy.Video 1Endoscopic retrograde cholangiopancreatography (ERCP) was performed on a 90-year-old woman with acute cholangitis and a history of distal gastrectomy (Billroth-II reconstruction) ([Fig. 1] a, b). During insertion of the scope, a perforation was observed in the afferent loop, which was sutured with some clips. Because the intrahepatic bile duct was dilated ([Fig. 1] b), we decided to perform EUS-HGS for drainage. The B2 bile duct was punctured from the stomach using a 19-gauge needle, and a 0.025-inch guidewire (Visiglide2; Olympus Inc., Tokyo, Japan) was placed into the common bile duct.
During placement of a 6-Fr endoscopic nasobiliary drainage (ENBD) tube, the guidewire flexed in the stomach and was difficult to restraighten by guidewire and scope manipulation. The guidewire was therefore grasped with biopsy forceps (1C Biopsy Forceps, 1.8 mm; Micro-Tech Co., Ltd., Nanjing, China), and we were able to straighten and shorten it by simply pulling it out through the forceps channel ([Fig. 2] and [Fig. 3]). An ENBD was inserted up to the duodenum to complete the procedure. The subsequent course of the perforation and acute cholangitis was uneventful. Stone removal was difficult owing to stenosis of the afferent loop, so the patient was discharged about 2 weeks after drainage with a plastic stent.
The use of the double-guidewire technique for safe guidewire use has also been reported [3]. Our technique may be simple and useful, not only in EUS-HGS, but also in ERCP and other EUS-related interventions.
Endoscopy_UCTN_Code_CPL_1AL_2AD
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Publication History
Article published online:
17 December 2024
© 2024. The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution License, permitting unrestricted use, distribution, and reproduction so long as the original work is properly cited. (https://creativecommons.org/licenses/by/4.0/).
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References
- 1 Vila JJ, Pérez-Miranda M, Vazquez-Sequeiros E. et al. Initial experience with EUS-guided cholangiopancreatography for biliary and pancreatic duct drainage: a Spanish national survey. Gastrointest Endosc 2012; 76: 1133-1141
- 2 Paik WH, Park DH. Outcomes and limitations: EUS-guided hepaticogastrostomy. Endosc Ultrasound 2019; 8: S44-S49
- 3 Kawakami H, Kubota Y, Makiyama H. et al. Uneven double-lumen cannula for rescue guidewire technique in endoscopic ultrasonography-guided hepaticogastrostomy. Endoscopy 2017; 49: E264-E265