Post written by Takaoki Hayakawa, MD, from the Division of Gastroenterology and Hepatology, Department of Internal Medicine, School of Medicine, Keio University, Tokyo, Japan.

Endoscopic transpapillary gallbladder drainage is an effective treatment for acute cholecystitis in patients who cannot undergo surgery because of adverse events or bleeding tendencies.

This video describes the use of a new ultra-tapered endoscopic nasobiliary drainage (ENBD) tube in an 83-year-old woman with cholecystitis. We initially attempted endoscopic gallbladder stenting with hydrophilic-coated and conventional guidewires and 3-mm balloon catheters.

However, the catheters were stuck in the middle of the cystic duct bend and could not be advanced. Therefore, endoscopic gallbladder stenting was abandoned, and an ultra-tapered ENBD tube was advanced along the guidewire. Although there was some resistance at the bend, the cystic duct passed through, and endoscopic transpapillary gallbladder drainage was successfully performed.

Failure of gallbladder drainage is not uncommon because the cystic duct is sometimes too bent or narrow because of inflammation. We focused on the improvement of stents as a solution to this problem.

In cases of narrow and curved cystic ducts that cannot be passed, even with commonly used tapered catheters, the newly developed ultra-tapered ENBD tube is worth a try for possible successful drainage.

Newly developed endoscopic nasobiliary drainage (ENBD) tube (tip diameter, 3.3F; outer diameter, 5F; HANACO Medical, Saitama, Japan): an image of the tip of the newly developed ENBD and enlarged images of the tips of the conventional tubes through a 0.025-inch guidewire. The step between the ultra-tapered ENBD tube tip and the guidewire is extremely small, allowing easy passage through the cystic duct.

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