Post written by Kavel H. Visrodia, MD, from the Division of Gastroenterology, Massachusetts General Hospital, Boston, Massachusetts.

In this video case series, we describe 3 distinct cases in which the use of a double-lumen cytology brush catheter to place 2 guidewires facilitated successful endoscopic interventions. The first is a case of an endoscopic retrograde cholangiopancreatography (ERCP) performed to upsize a transpapillary gallbladder stent from 1 to 2 plastic stents. The second is a case of endoscopic ultrasound (EUS) transgastric drainage of a pseudocyst via placement of 2 plastic stents. The third is an ERCP case for placement of 2 plastic stents through a severe malignant common bile duct stricture.

Placing multiple guidewires is not uncommon when performing endoscopic interventions, particularly to facilitate placement of multiple stents. However, it can be challenging, time-consuming, and sometimes unattainable to pass a second guidewire, especially in the setting of a severe stricture or during transmural interventions. Specialized multiple-lumen catheters to assist with this procedural step have been designed but may not be readily available in many endoscopy units. Therefore, we demonstrate the off-label use of a more commonly used double-lumen cytology brush catheter to achieve simultaneous placement of 2 guidewires.

There are several advantages to the placement of multiple guidewires, including potential improvement in procedural efficiency, maintenance of a safety track, and augmenting therapy (ie, multiple stenting). This relatively simple modification of a double-lumen cytology brush may lower the threshold for attempting multiple guidewire placements and facilitate endoscopic interventions, especially for complex clinical scenarios like those presented in our video case series.

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