Post written by Yoshihide Kanno, MD, from the Department of Gastroenterology, Sendai City Medical Center, Sendai, Japan.
We presented a case of a patient with a surgically altered gastrointestinal anatomy who underwent EUS-guided hepaticogastrostomy (EUS-HGS) using a combination of a newly developed 0.018-inch guidewire, a dedicated thin dilator, and a 22-gauge needle.
We often encounter patients who need biliary drainage by puncturing an intrahepatic bile duct, and such drainage has been performed using percutaneous transhepatic biliary drainage (PTBD) or EUS-HGS. If EUS-HGS can be performed using 22-gauge needles, its technical feasibility for use in thin ducts would substantially increase. EUS-HGS might become superior to PTBD owing to finer image quality and decreased radiation exposure for operators, especially their hands.
The newly developed Fielder 18TM is relatively stiff despite its thin caliber of 0.018 inches, enabling device insertion without needing to exchange the guidewire. We felt it was important to showcase this video because this guidewire would become the choice for EUS-HGS when target ducts are extremely thin.
The Fielder 18TM can be used for EUS-HGS in intrahepatic ducts with a thin diameter of 1‒3 mm. The dedicated dilator appeared useful for dilating puncture routes. When the rigidity is insufficient to insert a stent, it can be exchanged with a thicker one after dilation of the puncture route.
Previous guidewires with an ultrathin diameter, such as a 0.018-inch NovaGoldTM (Boston Scientific), a 0.018-inch PathFinderTM (Boston Scientific), a 0.018-inch MTW guidewire (MTW), and a 0.021-inch Tracer Metro DirectTM (Cook), did not have sufficient maneuverability and stiffness to advance devices. These guidewires could be applied for EUS-HGS only in rendezvous approaches. Further evaluation of the Fielder 18TM for EUS-HGS is warranted.
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