Use of a double-lumen cytology brush catheter to allow double-guidewire technique for endoscopic interventions

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

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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.

Read the full article online.

The information presented in Endoscopedia reflects the opinions of the authors and does not represent the position of the American Society for Gastrointestinal Endoscopy (ASGE). ASGE expressly disclaims any warranties or guarantees, expressed or implied, and is not liable for damages of any kind in connection with the material, information, or procedures set forth.

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