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CC BY 4.0 · Endoscopy 2026; 58(S 01): E111-E112
DOI: 10.1055/a-2760-9144
E-Videos

Novel needle system for transmural access in therapeutic endoscopic ultrasound

Authors

  • Stefano Mazza 

    1   Gastroenterology and Digestive Endoscopy Unit, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy (Ringgold ID: RIN18631)

  • Davide Scalvini 

    1   Gastroenterology and Digestive Endoscopy Unit, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy (Ringgold ID: RIN18631)
    2   Department of Internal Medicine and Medical Therapeutics, University of Pavia, Pavia, Italy (Ringgold ID: RIN19001)

  • Aurelio Mauro 

    1   Gastroenterology and Digestive Endoscopy Unit, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy (Ringgold ID: RIN18631)

  • Marco Bardone

    1   Gastroenterology and Digestive Endoscopy Unit, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy (Ringgold ID: RIN18631)

  • Daniele Alfieri

    1   Gastroenterology and Digestive Endoscopy Unit, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy (Ringgold ID: RIN18631)
    2   Department of Internal Medicine and Medical Therapeutics, University of Pavia, Pavia, Italy (Ringgold ID: RIN19001)

  • Francesca Torello Viera

    1   Gastroenterology and Digestive Endoscopy Unit, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy (Ringgold ID: RIN18631)

  • Andrea Anderloni

    1   Gastroenterology and Digestive Endoscopy Unit, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy (Ringgold ID: RIN18631)
    2   Department of Internal Medicine and Medical Therapeutics, University of Pavia, Pavia, Italy (Ringgold ID: RIN19001)
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Endoscopic ultrasound (EUS)-guided transmural access has expanded dramatically over the last decade and now plays a pivotal role in biliary drainage as an alternative to endoscopic retrograde cholangiopancreatography (ERCP [1] [2]). Electrocautery-enhanced lumen apposing metal stents with the free-hand technique, which allow for a single-step, single-device procedure, have strongly contributed to such an expansion, although many procedures still require a Seldinger approach involving access with needle puncture and guidewire positioning in the biliary system [2] [3] [4]. However, these are demanding techniques and dedicated devices that facilitate the technical execution of the procedure are lacking.

Three patients aged between 68 and 84 years presented with malignant biliary obstruction, two located distally and one perihilar, treated with EUS-guided biliary drainage after ERCP failure. All procedures required the “classic” approach, for which a new EUS-guided access needle device specifically designed for transmural access was used (SonoTip AccessPro, Medi-Globe, Rohrdorf, Germany). The device is shown in detail in [Video 1].

The SonoTip AccessPro needle for EUS-guided transmural access is introduced, and its use during an EUS-guided hepaticogastrostomy is shown. EUS, endoscopic ultrasound.Video 1

The perihilar obstruction was due to a large metastatic lymphadenopathy, with ERCP not feasible because of duodenal infiltration at the duodenal neck. In this case, endoscopic ultrasound-guided hepaticogastrostomy was performed. After accessing the B2 segment intrahepatic bile ducts from the stomach, the guidewire was advanced beyond the obstruction into the common bile duct. A dedicated partially covered metal stent was placed ([Video 1]).

In the two cases of distal obstruction, papillary cannulation was not possible, and EUS-guided biliary drainage was not feasible because of insufficient bile duct dilation. Thus, EUS-guided rendezvous ERCP was performed, in one case with access from the common bile duct and side-by-side papillary cannulation ([Fig. 1]) and in the other case with access from the left intrahepatic bile ducts and over-the-wire cannulation ([Fig. 2]). A transpapillary fully covered metal stent was placed in both cases.

Zoom
Fig. 1 a EUS-guided access to the common bile duct and guidewire advancement through the papilla into the duodenal lumen. b Endoscopic retrieval of the guidewire end exiting from the papilla. c Over-the-guidewire cannulation. d Transpapillary biliary stent deployment. EUS, endoscopic ultrasound.
Zoom
Fig. 2 a EUS-guided access to the left intrahepatic bile duct and guidewire advancement through the papilla into the duodenal lumen. b An endoscopic view of side-by-side cannulation. c A Fluoroscopic view of side-by-side cannulation and retrograde guidewire positioning. d Transpapillary biliary stent deployment. EUS, endoscopic ultrasound.

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Contributorsʼ Statement

Stefano Mazza: Conceptualization, Software, Visualization, Writing – original draft. Davide Scalvini: Software, Writing – original draft, Writing – review & editing. Aurelio Mauro: Writing – review & editing. Marco Bardone: Visualization, Writing – review & editing. Daniele Alfieri: Data curation, Software, Writing – review & editing. Francesca Torello Viera: Writing – review & editing. Andrea Anderloni: Conceptualization, Investigation, Writing – review & editing.

Conflict of Interest

The authors declare that they have no conflict of interest.


Correspondence

Stefano Mazza, MD
Gastroenterology and Digestive Endoscopy Unit, Fondazione IRCCS Policlinico San Matteo
Viale Camillo Golgi
27100 Pavia
Italy   

Publication History

Article published online:
22 January 2026

© 2026. 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/).

Georg Thieme Verlag KG
Oswald-Hesse-Straße 50, 70469 Stuttgart, Germany


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Zoom
Fig. 1 a EUS-guided access to the common bile duct and guidewire advancement through the papilla into the duodenal lumen. b Endoscopic retrieval of the guidewire end exiting from the papilla. c Over-the-guidewire cannulation. d Transpapillary biliary stent deployment. EUS, endoscopic ultrasound.
Zoom
Fig. 2 a EUS-guided access to the left intrahepatic bile duct and guidewire advancement through the papilla into the duodenal lumen. b An endoscopic view of side-by-side cannulation. c A Fluoroscopic view of side-by-side cannulation and retrograde guidewire positioning. d Transpapillary biliary stent deployment. EUS, endoscopic ultrasound.