Endoscopy 2019; 51(11): E349-E351
DOI: 10.1055/a-0929-4645
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Successful endoscopic transpapillary gallbladder stenting using a new easily maneuverable guidewire: a report of two cases

Katsuyuki Miyabe*
Department of Gastroenterology and Metabolism, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan
,
Akihisa Kato*
Department of Gastroenterology and Metabolism, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan
,
Go Asano
Department of Gastroenterology and Metabolism, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan
,
Yasuki Hori
Department of Gastroenterology and Metabolism, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan
,
Michihiro Yoshida
Department of Gastroenterology and Metabolism, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan
,
Itaru Naitoh
Department of Gastroenterology and Metabolism, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan
,
Kazuki Hayashi
Department of Gastroenterology and Metabolism, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan
› Author Affiliations
Further Information

Corresponding author

Kazuki Hayashi, MD
Department of Gastroenterology and Metabolism
Nagoya City University Graduate School of Medical Sciences
1 Kawasumi
Mizuho-cho, Mizuho-ku Nagoya 467-8601
Japan   

Publication History

Publication Date:
07 June 2019 (online)

 

Endoscopic transpapillary gallbladder drainage has a poor technical success rate (80 % – 90 %) [1] [2] [3] [4]. The technique is sometimes challenging when the guidewire cannot be advanced through the cystic duct into the gallbladder because of ductal tortuosity or obstruction [5] ([Fig. 1]). This report describes a new, easily maneuverable guidewire (approved by the review board of Nagoya City University Graduate School of Medical Sciences; approval No. 46-18-0012), which was successfully advanced into the gallbladders of two patients in whom a conventional guidewire could not be advanced ([Fig. 2], [Video 1]).

Zoom Image
Fig. 1 Difficult passage of a guidewire through the cystic duct into the gallbladder. Regular guidewires often fail to pass through the duct because of control difficulty with “popping up” of its flexible tip portion (blue and yellow arrows). a Fluoroscopic images and schematic diagrams. b, c Close-up photos of the flexible tip in a phantom model of the bile duct.
Zoom Image
Fig. 2 Improved passage of an M-through guidewire (ASAHI INTECC Corp., Seto, Japan) through the cystic duct into the gallbladder. The novel flexible tip portion avoids being popped up and allows smooth control of the guidewire during advancement through a tortuous cystic duct (blue and yellow arrows). a Fluoroscopic images and schematic diagrams. b, c Close-up photos of the flexible tip in a phantom model of the bile duct.

Video 1 Two cases of endoscopic transpapillary gallbladder stenting using a new easy maneuverable guidewire.


Quality:

Case 1: an 83-year-old man developed epigastralgia caused by acute cholecystitis 3 days after percutaneous coronary intervention to treat acute coronary syndrome. As he was at risk of requiring anticoagulation therapy, percutaneous transhepatic gallbladder drainage was performed on the same day, and a choledocholithiasis was detected via cholangiography ([Fig. 3]). Then, 3 months later, after his heart condition had stabilized, we performed endoscopic choledocholithiasis extraction and endoscopic transpapillary gallbladder stenting (ETGS) to remove the percutaneous catheter and prevent future acute cholecystitis.

Zoom Image
Fig. 3 Case 1 (83-year-old man): cholangiography revealed a small choledocholithiasis that had originated from the gallbladder (yellow circle).

Case 2: a 65-year-old man was admitted with epigastralgia caused by recurrent acute cholecystitis; he was awaiting preventative cholecystectomy ([Fig. 4]). A new choledocholithiasis originating from the gallbladder was detected on computed tomography; we extracted it and then performed subsequent ETGS as a bridge to cholecystectomy.

Zoom Image
Fig. 4 Case 2 (65-year-old man): computed tomography revealed gallbladder swelling with wall thickening and pericholecystic fat stranding, suggestive of acute cholecystitis.

In both cases, tortuous cystic ducts hindered the advancement of a regular guidewire, with “popping up” of its flexible tip portion ([Fig. 1]). Therefore, we used the improved M-through guidewire (ASAHI INTECC Corp., Seto, Japan), which was maneuvered easily and was successfully passed through both cystic ducts; we placed plastic stents along the guidewires. The new guidewire has an innovative tip allowing smooth tracking and easy maneuverability. This guidewire was passed rapidly through tortuous cystic ducts, followed by plastic stent placement in the gallbladder ([Fig. 5]).

Zoom Image
Fig. 5 A fluoroscopic image obtained after performing endoscopic transpapillary gallbladder stenting in Case 1. A 5 Fr × 13 cm single-pigtail stent (Gadelius Medical K. K., Sagamihara, Japan) was finally placed along the guidewire into the gallbladder.

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Competing interests

None

Acknowledgments

The improved M-through guidewires were gifts from ASAHI INTECC Corp.

* These authors contributed equally to this work.


  • References

  • 1 Itoi T, Coelho-Prabhu N, Baron TH. Endoscopic gallbladder drainage for management of acute cholecystitis. Gastrointest Endosc 2010; 71: 1038-1045
  • 2 Oh D, Song TJ, Cho DH. et al. EUS-guided cholecystostomy versus endoscopic transpapillary cholecystostomy for acute cholecystitis in high-risk surgical patients. Gastrointest Endosc 2018; 10: 33011-33016
  • 3 Yang MJ, Yoo BM, Kim JH. et al. Endoscopic naso-gallbladder drainage versus gallbladder stenting before cholecystectomy in patients with acute cholecystitis and a high suspicion of choledocholithiasis: a prospective randomised preliminary study. Scand J Gastroenterol 2016; 51: 472-478
  • 4 Itoi T, Kawakami H, Katanuma A. et al. Endoscopic nasogallbladder tube or stent placement in acute cholecystitis: a preliminary prospective randomized trial in Japan (with videos). Gastrointest Endosc 2015; 81: 111-118
  • 5 Widmer J, Alvarez P, Sharaiha RZ. et al. Endoscopic gallbladder drainage for acute cholecystitis. Clin Endosc 2015; 48: 411-420

Corresponding author

Kazuki Hayashi, MD
Department of Gastroenterology and Metabolism
Nagoya City University Graduate School of Medical Sciences
1 Kawasumi
Mizuho-cho, Mizuho-ku Nagoya 467-8601
Japan   

  • References

  • 1 Itoi T, Coelho-Prabhu N, Baron TH. Endoscopic gallbladder drainage for management of acute cholecystitis. Gastrointest Endosc 2010; 71: 1038-1045
  • 2 Oh D, Song TJ, Cho DH. et al. EUS-guided cholecystostomy versus endoscopic transpapillary cholecystostomy for acute cholecystitis in high-risk surgical patients. Gastrointest Endosc 2018; 10: 33011-33016
  • 3 Yang MJ, Yoo BM, Kim JH. et al. Endoscopic naso-gallbladder drainage versus gallbladder stenting before cholecystectomy in patients with acute cholecystitis and a high suspicion of choledocholithiasis: a prospective randomised preliminary study. Scand J Gastroenterol 2016; 51: 472-478
  • 4 Itoi T, Kawakami H, Katanuma A. et al. Endoscopic nasogallbladder tube or stent placement in acute cholecystitis: a preliminary prospective randomized trial in Japan (with videos). Gastrointest Endosc 2015; 81: 111-118
  • 5 Widmer J, Alvarez P, Sharaiha RZ. et al. Endoscopic gallbladder drainage for acute cholecystitis. Clin Endosc 2015; 48: 411-420

Zoom Image
Fig. 1 Difficult passage of a guidewire through the cystic duct into the gallbladder. Regular guidewires often fail to pass through the duct because of control difficulty with “popping up” of its flexible tip portion (blue and yellow arrows). a Fluoroscopic images and schematic diagrams. b, c Close-up photos of the flexible tip in a phantom model of the bile duct.
Zoom Image
Fig. 2 Improved passage of an M-through guidewire (ASAHI INTECC Corp., Seto, Japan) through the cystic duct into the gallbladder. The novel flexible tip portion avoids being popped up and allows smooth control of the guidewire during advancement through a tortuous cystic duct (blue and yellow arrows). a Fluoroscopic images and schematic diagrams. b, c Close-up photos of the flexible tip in a phantom model of the bile duct.
Zoom Image
Fig. 3 Case 1 (83-year-old man): cholangiography revealed a small choledocholithiasis that had originated from the gallbladder (yellow circle).
Zoom Image
Fig. 4 Case 2 (65-year-old man): computed tomography revealed gallbladder swelling with wall thickening and pericholecystic fat stranding, suggestive of acute cholecystitis.
Zoom Image
Fig. 5 A fluoroscopic image obtained after performing endoscopic transpapillary gallbladder stenting in Case 1. A 5 Fr × 13 cm single-pigtail stent (Gadelius Medical K. K., Sagamihara, Japan) was finally placed along the guidewire into the gallbladder.