Endoscopy 2021; 53(06): E217-E218
DOI: 10.1055/a-1244-9842
E-Videos

One-step puncture and dilation with fine-gauge electrocautery dilator for endoscopic ultrasound-guided gallbladder drainage

Koichiro Mandai
Department of Gastroenterology, Kyoto Second Red Cross Hospital, Kyoto, Japan
,
Tetsuhisa Ko
Department of Gastroenterology, Kyoto Second Red Cross Hospital, Kyoto, Japan
,
Koji Uno
Department of Gastroenterology, Kyoto Second Red Cross Hospital, Kyoto, Japan
,
Kenjiro Yasuda
Department of Gastroenterology, Kyoto Second Red Cross Hospital, Kyoto, Japan
› Author Affiliations
 

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 [1] [2] [3]. Herein we describe a successful one-step puncture and tract dilation using this dilator during EUS-guided gallbladder drainage (EUS-GBD).

Zoom Image
Fig. 1 The novel fine-gauge electrocautery dilator (Fine 025, Medico’s Hirata Inc., Osaka, Japan). The distal end of the outer dilator has a 3-Fr metal tip. This electrocautery dilator is wire-guided and coaxial with a 0.025-inch guidewire. In addition, contrast medium injection is possible under guidewire loading.

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]).

Zoom Image
Fig. 2 Endoscopic ultrasound image shows that the gallbladder was successfully punctured by the fine-gauge electrocautery dilator (red arrow).
Zoom Image
Fig. 3 Contrast medium injection was possible under guidewire loading (red arrow). A plastic stent placed one and a half years earlier during endoscopic ultrasound-guided hepaticogastrostomy for the management of cholangitis was recognized (yellow arrow).
Zoom Image
Fig. 4 A 7-Fr double-pigtail plastic stent was placed within a fully covered metal stent.

Video 1 Puncture and tract dilation in one step using a fine-gauge electrocautery dilator during endoscopic ultrasound-guided gallbladder drainage.


Quality:

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.

Endoscopy_UCTN_Code_TTT_1AS_2AD

Endoscopy E-Videos is a free access online section, reporting on interesting cases and new techniques in gastroenterological endoscopy. All papers include a high
quality video and all contributions are
freely accessible online.

This section has its own submission
website at
https://mc.manuscriptcentral.com/e-videos


#

Competing interests

The authors declare that they have no conflict of interest.


Corresponding author

Koichiro Mandai, MD
Department of Gastroenterology
Kyoto Second Red Cross Hospital
355-5 Haruobi-cho
Kamigyo-ku
Kyoto 602-8026
Japan   
Fax: +81-75-256-3451   

Publication History

Publication Date:
11 September 2020 (online)

© 2020. Thieme. All rights reserved.

Georg Thieme Verlag KG
Rüdigerstraße 14, 70469 Stuttgart, Germany


Zoom Image
Fig. 1 The novel fine-gauge electrocautery dilator (Fine 025, Medico’s Hirata Inc., Osaka, Japan). The distal end of the outer dilator has a 3-Fr metal tip. This electrocautery dilator is wire-guided and coaxial with a 0.025-inch guidewire. In addition, contrast medium injection is possible under guidewire loading.
Zoom Image
Fig. 2 Endoscopic ultrasound image shows that the gallbladder was successfully punctured by the fine-gauge electrocautery dilator (red arrow).
Zoom Image
Fig. 3 Contrast medium injection was possible under guidewire loading (red arrow). A plastic stent placed one and a half years earlier during endoscopic ultrasound-guided hepaticogastrostomy for the management of cholangitis was recognized (yellow arrow).
Zoom Image
Fig. 4 A 7-Fr double-pigtail plastic stent was placed within a fully covered metal stent.