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DOI: 10.1055/a-2318-2938
Utility of uneven double-lumen catheter for difficult guidewire manipulation in endoscopic ultrasonography-guided pancreaticogastrostomy
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Endoscopic ultrasonography-guided pancreaticogastrostomy (EUS-PGS) is a challenging procedure, and the most difficult step is guidewire insertion to the appropriate portion. We report herein a case in which the guidewire was not advanced in the correct direction after puncture during EUS-PGS, and a double-lumen catheter was used to correct the direction of the guidewire.
A 57-year-old man who had undergone subtotal stomach-preserving pancreaticoduodenectomy 5 years previously was referred to our department for management of recurrent pancreatitis due to pancreaticojejunostomy stenosis (PJS). As pancreatic access with balloon-assisted endoscopy had failed at the previous institution, we performed EUS-PGS with antegrade stenting across the PJS. We successfully punctured the main pancreatic duct (MPD) from the stomach with a 19-gauge needle (EZ Shot 3 Plus; Olympus Medical Systems, Tokyo, Japan) and injected contrast medium. A 0.025-inch angled guidewire (VisiGlide 2; Olympus Medical Systems) was then placed in the tail of the MPD because insertion toward the anastomotic site had failed ([Fig. 1]). We kept the guidewire in the MPD and dilated the puncture tract with a bougie dilator (ES Dilator; Zeon Medical, Tokyo, Japan). We inserted an uneven double-lumen cannula (Piolax Medical Devices, Yokohama, Japan) with an additional a 0.025-inch guidewire (EndoSelector; Boston Scientific Japan, Tokyo, Japan) in the other lumen. The additional guidewire was inserted into the opposite side and then passed across the PJS ([Fig. 2]). The PJS and puncture tract were dilated with a balloon dilator (REN 4 mm; Kaneka, Tokyo, Japan). Finally, a 7-Fr, 15-cm, double-pigtail stent (Zimmon Biliary Stent; Cook Medical, Bloomington, Indiana, USA) was placed across the PJS ([Fig. 3], [Video 1]).
A double-lumen catheter was useful for changing the guidewire to the opposite side during EUS-PGS when the guidewire was not oriented in the correct direction.
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Conflict of Interest
H. Isayama has received research grants from Boston Scientific Japan and FUJIFILM Corporation. The funding source had no role in the design, practice, or analysis of this study. A. Machida, Y. Takasaki, S. Takahashi, A. Suzuki, S. Ishii, and T. Fujisawa declare that they have no conflict of interest.
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Publication History
Article published online:
04 July 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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