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DOI: 10.1055/s-0042-124498
Novel wire-guided fine-gauge bougie dilator for transpapillary or endoscopic ultrasonography-guided biliary drainage
Corresponding author
Publikationsverlauf
Publikationsdatum:
31. Januar 2017 (online)
Endoscopic management of biliary stricture generally requires dilation using devices such as an endoscopic retrograde cholangiopancreatography (ERCP) balloon dilation catheter before stenting [1]. Endoscopic ultrasonography (EUS)-guided biliary drainage (EUS-BD) also requires fistula dilation before stenting. Recently, ultraslim balloon catheters [1] and diathermic dilators [2] have also been developed as dilation devices. These devices must be wire-guided, coaxial with the guidewire, fine-gauge, and sufficiently stiff.
Herein, we present two patients who successfully underwent biliary dilation using a novel wire-guided fine-gauge bougie dilator (ES dilator soft type; Zeon Medical Inc., Tokyo, Japan) ([Fig. 1] and [Fig. 2]) for transpapillary drainage and EUS-BD.
![](https://www.thieme-connect.de/media/endoscopy/2017S01/thumbnails/10-1055-s-0042-124498-i0001cl1.jpg)
![Zoom Image](/products/assets/desktop/css/img/icon-figure-zoom.png)
![](https://www.thieme-connect.de/media/endoscopy/2017S01/thumbnails/10-1055-s-0042-124498-i0001cl2.jpg)
![Zoom Image](/products/assets/desktop/css/img/icon-figure-zoom.png)
The first patient was a 79-year-old man who was admitted with obstructive jaundice having undergone placement of self-expandable metal stents (SEMSs) for perihilar bile duct cancer 5 months previously. An ERCP showed occlusion of the SEMSs ([Fig. 3 a]). First, a 0.025-inch hard-type guidewire (VisiGlide 2; Olympus, Tokyo, Japan) was advanced across the occluded SEMSs. A tapered ERCP catheter and a dilation catheter (SBDC-6; Cook Japan, Tokyo, Japan) could not be passed through the stricture ([Video 1]). The novel dilator was then inserted, resulting in successful passage through the occluded SEMSs ([Fig. 3 b]; [Video 1]). Finally, an uncovered SEMS was placed without any complications.
![](https://www.thieme-connect.de/media/endoscopy/2017S01/thumbnails/10-1055-s-0042-124498-i0001cl3.jpg)
![Zoom Image](/products/assets/desktop/css/img/icon-figure-zoom.png)
Qualität:
The second patient was an 85-year-old man who was admitted with obstructive jaundice and a history of total gastrectomy and Roux-en-Y reconstruction for gastric cancer 21 years previously. A computed tomography (CT) scan showed an ampullary tumor and treatment by EUS-BD was selected. Firstly, B3 was punctured with a 19-gauge needle via the jejunum and a 0.025-inch hard-type guidewire (VisiGlide 2; Olympus) was placed. A tapered ERCP catheter was tried without success to dilate the fistula. Subsequently, dilation with the novel dilator was attempted, and this was successfully inserted into the intrahepatic bile duct ([Fig. 4]; [Video 2]). Finally, EUS-guided antegrade stenting was performed without any complications ([Video 2]).
![](https://www.thieme-connect.de/media/endoscopy/2017S01/thumbnails/10-1055-s-0042-124498-i0001cl4.jpg)
![Zoom Image](/products/assets/desktop/css/img/icon-figure-zoom.png)
Qualität:
The novel wire-guided fine-gauge bougie dilator is useful for both transpapillary and fistula dilation in EUS-BD owing to its ideal thickness and stiffness.
Endoscopy_UCTN_Code_TTT_1AS_2AD
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Competing interests
The novel bougie dilator has been developed through collaborative research between Dr. Kawakami and Zeon Medical Inc., Tokyo, Japan. Dr. Kawakami is a consultant and gives lectures for the Zeon Medical Inc. The authors declare no conflict of interests for this article.
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References
- 1 Kawakami H, Kuwatani M, Kawakubo K. et al. Transpapillary dilation of refractory severe biliary stricture or main pancreatic duct by using a wire-guided diathermic dilator (with video). Gastrointest Endosc 2014; 79: 1-3
- 2 Ogura T, Takagi W, Onda S. et al. Endoscopic ultrasound-guided biliary drainage with a novel fine-gauge balloon catheter: simplified technique using a coaxial guidewire. Endoscopy 2015; 47: E573-E574
Corresponding author
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References
- 1 Kawakami H, Kuwatani M, Kawakubo K. et al. Transpapillary dilation of refractory severe biliary stricture or main pancreatic duct by using a wire-guided diathermic dilator (with video). Gastrointest Endosc 2014; 79: 1-3
- 2 Ogura T, Takagi W, Onda S. et al. Endoscopic ultrasound-guided biliary drainage with a novel fine-gauge balloon catheter: simplified technique using a coaxial guidewire. Endoscopy 2015; 47: E573-E574
![](https://www.thieme-connect.de/media/endoscopy/2017S01/thumbnails/10-1055-s-0042-124498-i0001cl1.jpg)
![Zoom Image](/products/assets/desktop/css/img/icon-figure-zoom.png)
![](https://www.thieme-connect.de/media/endoscopy/2017S01/thumbnails/10-1055-s-0042-124498-i0001cl2.jpg)
![Zoom Image](/products/assets/desktop/css/img/icon-figure-zoom.png)
![](https://www.thieme-connect.de/media/endoscopy/2017S01/thumbnails/10-1055-s-0042-124498-i0001cl3.jpg)
![Zoom Image](/products/assets/desktop/css/img/icon-figure-zoom.png)
![](https://www.thieme-connect.de/media/endoscopy/2017S01/thumbnails/10-1055-s-0042-124498-i0001cl4.jpg)
![Zoom Image](/products/assets/desktop/css/img/icon-figure-zoom.png)