Endoscopic ultrasound‐guided covered metal stent deployment through endoscopic tapered sheath preventing bile leakage

Abstract

BRIEF EXPLANATION E NDOSCOPIC ULTRASOUND-GUIDED BILIARY drainage (EUS-BD) is a promising treatment option for patients with biliary obstruction. 1-3 However, EUS-BD may be associated with serious complications, especially bile leakage which may cause fatal peritonitis. 4 Although various techniques have been used for dilation, bile can leak after fistula dilation with any techniques. The duration of the procedure, from dilation to stent deployment, should be reduced, or ideally, eliminated to prevent severe adverse events. To achieve this, we first designed a new technique for covered metal stent deployment using a tapered sheath (EndoSheather; Piolax, Kanagawa, Japan) 5 preventing bile leakage. This device allows fistula dilation and subsequent smooth stent delivery through the indwelling outer-sheath, which provides a secure route to cross the fistula without any concern.An 81-year-old female was admitted with pancreatic ductal adenocarcinoma and obstructive jaundice (Fig. 1). Combined EUS-guided hepaticogastrostomy (EUS-HGS) with antegrade stenting (EUS-AS) was performed. Under EUS guidance, the B3 bile duct was punctured with a 19gauge needle, and a 0.025-inch guidewire was subsequently advanced into the duodenum in an antegrade fashion. Then, the endoscopic sheath, with a tapered inner-catheter tip, was inserted into the bile duct to dilate the fistula (Fig. 2). After passing this device through the biliary stricture, only the inner-catheter was removed, leaving the outer-sheath inside the bile duct. Finally, an uncovered metal stent (8 9 60 mm) with a 5.7-Fr delivery system (BileRush Selective; Piolax) for EUS-AS and a covered metal stent

Successful removal of a migrated plastic stent using a new endoscopic sheath

“…It also allows stent removal without requiring a guidewire to be maneuvered through the stent, as is necessary for stent removal using a drill dilator 3 . There have also been reports of the EndoSheather being used for removal of a migrated plastic stent 4 and for stent deployment during endoscopic ultrasound-guided biliary drainage 5 .…”