Endoscopic ultrasonography-guided hepaticoduodenostomy using a novel self-expandable metallic stent with an ultra-tapered tip and a slim-delivery system

Endoscopic ultrasonography-guided hepaticoduodenostomy (EUS-HDS) is an effective treatment for biliary obstruction of the posterior branch; however, inserting the stent delivery system can be challenging in cases with an acute angle to the bile duct [1] [2] [3] [4] [5]. A novel partially covered self-expandable metallic stent (Niti-S EUS-BD system End Bare Single Flare; Taewoong Medical Co., Ltd.) with an ultra-tapered tip specifically designed for a 0.025-inch guidewire and 7-Fr slim delivery system facilitates transluminal stent insertion. Herein, we report a challenging case of EUS-HDS using the novel 7-Fr Niti-S stent ([Video 1]).

Endoscopic ultrasonography-guided hepaticoduodenostomy was successfully performed using a novel self-expandable metallic stent with an ultra-tapered tip and a 7-Fr slim delivery.Video 1

A 61-year-old woman with huge liver metastases of colon cancer was admitted due to hilar biliary obstruction. The intrahepatic bile duct was separately obstructed as Bismuth type IV. Initially, endoscopic ultrasonography-guided hepaticogastrostomy was performed; however, jaundice did not improve sufficiently ([Fig. 1]). Due to the presence of ascites around the right liver lobe, EUS-HDS was attempted as an alternative to percutaneous drainage ([Fig. 2]). The right posterior branch was punctured using a 19-gauge needle. High resistance was felt during puncture because the Glisson sheath was penetrated ([Fig. 3]). After the insertion of a 0.025-inch guidewire (VisiGlide 2; Olympus medical systems), an ultra-tapered catheter could not pass through the bile duct wall. Although a 7-Fr mechanical dilator (ES dilator soft type; Zeon Medical) was inserted into the posterior branch, the catheter still failed to advance. Subsequently, the novel 7-Fr Niti-S stent was attempted to insert into the bile duct. The ultra-tapered tip of the slim-delivery system easily advanced across the bile duct wall, and the 8-mm and 10-cm stent was successfully placed. Cholangiography confirmed no bile leakage into the abdominal cavity ([Fig. 4]).

Fig. 1 A novel 7-Fr Niti-S EUS-BD system End Bare Single Flare.

Fig. 2 A computed tomography image after endoscopic ultrasonography-guided hepaticogastrostomy shows ascites and dilated posterior branches (arrowhead).

Fig. 3 Ultrasound images during the procedure. a A 19-gauge needle penetrates the Glisson sheath around the bile duct (arrowhead). b A 7-Fr slim-delivery system of the novel Niti-S stent passes through the bile duct wall.

Fig. 4 Fluoroscopic images during the procedure. a The posterior branch is punctured, and a guidewire is inserted into the bile duct. b An ultra-tapered catheter fails to advance after dilation. c The novel 7-Fr Niti-S stent can be inserted into the bile duct. d The stent is successfully deployed to the duodenum.

To the best of our knowledge, this is the first report of successful EUS-HDS using the novel 7-Fr Niti-S stent with an ultra-tapered tip and a slim-delivery system.

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Publikationsverlauf

Artikel online veröffentlicht:
19. Mai 2025

• References

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