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CC BY 4.0 · Endoscopy 2024; 56(S 01): E928-E929
DOI: 10.1055/a-2436-6980
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Successful reintervention using a novel steerable catheter after dislocation of a transluminal gallbladder stent

Authors

  • Takeshi Ogura

    1   Endoscopy Center, Osaka Medical and Pharmaceutical University Hospital, Takatsuki, Japan
    2   2nd Department of Internal Medicine, Osaka Medical and Pharmaceutical University, Takatsuki, Japan

  • Yuki Uba

    2   2nd Department of Internal Medicine, Osaka Medical and Pharmaceutical University, Takatsuki, Japan

  • Nobuhiro Hattori

    2   2nd Department of Internal Medicine, Osaka Medical and Pharmaceutical University, Takatsuki, Japan

  • Kimi Bessho

    2   2nd Department of Internal Medicine, Osaka Medical and Pharmaceutical University, Takatsuki, Japan

  • Hiroki Nishikawa

    2   2nd Department of Internal Medicine, Osaka Medical and Pharmaceutical University, Takatsuki, Japan
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Endoscopic ultrasound-guided gallbladder drainage (EUS-GBD) is indicated for acute cholecystitis in poor surgical candidates [1] [2]. Although technical tips for EUS-GBD have been well established, long-term outcomes after stent removal remain unclear. If acute cholecystitis recurs after stent removal, reintervention through the fistula between the gallbladder and stomach or duodenum should be considered. To perform reintervention, the guidewire should be inserted into the gallbladder. However, in the transduodenal approach, this procedure might be challenging due to the limited space available to manipulate the echoendoscope. Recently, a novel steerable catheter (Zeon Medical, Tokyo, Japan) has become available in Japan [3] [4]. This catheter can be manipulated upwards and downwards 90 degrees, and the fulcrum for the tip bend is closer to the tip (15 mm) ([Fig. 1]). Therefore, guidewire access to a challenging site can be performed easily. Successful reintervention using the novel steerable catheter after EUS-GBD stent dislocation is described below.

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Fig. 1 A novel steerable catheter (Zeon Medical, Tokyo, Japan).

An 88-year-old woman was admitted to our hospital with acute cholecystitis. She had undergone EUS-GBD from the duodenum for acute cholecystitis using a plastic stent 2 months earlier. However, computed tomography showed dislocation of the plastic stent. Therefore, reintervention was attempted.

A duodenoscope was inserted into the duodenum and the fistula was detected ([Fig. 2]). Guidewire insertion into the gallbladder was attempted; however, because the angle between the fistula and the gallbladder was acute ([Fig. 3] a), guidewire insertion failed. Guidewire insertion using the novel steerable catheter was then performed easily ([Fig. 3] b). After guidewire deployment within the gallbladder, a double-lumen catheter was also inserted along this guidewire; then, an additional guidewire was deployed. Finally, two double-pigtail plastic stents were deployed without any adverse events ([Fig. 3] c, [Video 1]).

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Fig. 2 A duodenoscope was inserted into the duodenum, and a fistula was detected.
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Fig. 3 Guidewire insertion and stent placement. a Guidewire insertion into the gallbladder was attempted but failed due to the acute angle between the fistula and the gallbladder. b Guidewire insertion using the novel steerable catheter was then performed. c Two double-pigtail plastic stents were deployed without any adverse events.
Guidewire insertion using a novel steerable catheter was successfully performed.Video 1

In conclusion, this novel catheter could be a useful option for successful selective guidewire insertion.

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Conflict of Interest

The authors declare that they have no conflict of interest.


Correspondence

Takeshi Ogura, MD, PhD, FJGES
Endoscopy Center, Osaka Medical College
2-7 Daigakuchou
Takatsuki, Osaka 569-8686
Japan   

Publication History

Article published online:
25 October 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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Zoom
Fig. 1 A novel steerable catheter (Zeon Medical, Tokyo, Japan).
Zoom
Fig. 2 A duodenoscope was inserted into the duodenum, and a fistula was detected.
Zoom
Fig. 3 Guidewire insertion and stent placement. a Guidewire insertion into the gallbladder was attempted but failed due to the acute angle between the fistula and the gallbladder. b Guidewire insertion using the novel steerable catheter was then performed. c Two double-pigtail plastic stents were deployed without any adverse events.