Endoscopic ultrasound-guided biliary drainage with a novel fine-gauge balloon catheter: one-step placement technique

Abstract

During endoscopic ultrasound-guided hepaticogastrostomy (EUS-HGS), it is necessary to dilate the fistula [1]. Graded dilation with a 4-Fr cannula and 6-and 7-Fr bougie dilators is relatively easily performed, and this stepwise procedure appears to be safe [2]. On the other hand, the use of a needle knife for fistula dilation in endoscopic ultrasound-guided biliary drainage (EUS-BD) may be associated with post-procedural adverse events [3]. These procedures have the potential to cause bile leakage because only the guidewire is placed between the bile duct and intestine across the abdominal cavity during the exchange of devices. There is a great need for a simplified technique to avoid such adverse events. A novel balloon catheter (ZARA; Century Medical, Tokyo, Japan) has two unique characteristics (• " Fig. 1). First, the tip of the balloon catheter is only 3 Fr in diameter and tapered. Second, the surface of the balloon catheter is rough. Therefore, the device is easily inserted following puncture with a 19-gauge needle, and during balloon dilation, the characteristics of the surface may be of clinical benefit in preventing malposition of the dilation site. An 80-year-old man was admitted because of vomiting and obstructive jaundice due to unresectable pancreatic cancer, which was obstructing the duodenum. First, we performed duodenal stenting. Next, we punctured the intrahepatic bile duct with a 19-gauge fine-needle aspiration needle and inserted a 0.025-inch stiff guidewire. The novel balloon catheter could then be smoothly inserted into the duodenum across the stricture site and duodenal stent. We dilated the stricture and duodenal stent to place the metallic stent, after which we used the novel balloon catheter to dilate the intrahepatic bile duct (• " Fig. 2) and stomach wall (• " Fig. 3). A metallic stent delivery system was then inserted in antegrade fashion and successfully placed at the lower bile duct. Finally, we performed the EUS-HGS (• " Fig. 4). No adverse events occurred.

Clinical utility of endoscopic ultrasound‐guided biliary drainage as a rescue of re‐intervention procedure for high‐grade hilar stricture

“…Because the guidewire placement diameter is relatively short compared with primary EUS‐BD, push ability may be lower. Therefore, a fine gauge balloon catheter or cystotome may be needed for this procedure. However, EUS‐BD also has a high rate of adverse events, such as stent migration or bile leakage; therefore, EUS‐BD should be performed by an experienced endoscopist, not only for primary EUS‐BD, but also for re‐intervention.…”

Endoscopic ultrasound-guided hepaticogastrostomy using a 6-F cystotome and 12-cm covered metal stent

“…Smooth fistula dilation was possible in all four of our cases; in addition, we achieved a mean procedure time of 27.5 minutes and did not encounter peritonitis due to bile leakage in any of our cases. Recently, another study reported the usefulness of a novel fine-gauge balloon catheter for hepaticogastric fistula dilation 3 . Further studies of safe and useful methods of fistula dilation are required.…”

Prospective clinical study of endoscopic ultrasound‐guided biliary drainage using novel balloon catheter (with video)

“…Figure shows the novel fine‐gage balloon catheters. The tip of these balloon catheters is only 3 Fr and tapered, and the catheters also show favorable push ability . The rapid type (ZARA EPBD balloon catheter; Century Medical, Tokyo, Japan) was mainly used for EUS‐CDS, as the guidewire was easily advanced into the appropriate site, such as the common bile duct (CBD).…”