Endoscopic ultrasound-guided hepaticogastrostomy using a 22G needle with a 0.018-inch ultra-stiff guidewire without tract dilation

Endoscopic ultrasound-guided hepaticogastrostomy using a 22G needle with a 0.018-inch ultra-stiff guidewire without tract dilation Endoscopic ultrasound-guided hepaticogastrostomy (EUS-HGS) is indicated for the treatment of malignant biliary strictures in cases where attempts at biliary drainage under endoscopic retrograde cholangiopancreatography have failed.Recently, EUS-HGS is also increasingly being performed for benign biliary diseases, such as common bile duct or hepaticojejunostomy strictures [1-3].However, since strictures cause greater narrowing of the intrahepatic bile duct than malignant biliary disease does, puncturing a stricture using a 19G needle is sometimes challenging.In such cases, using a 22G needle may enable successful puncture of the biliary tractbut there may still be a problem, because a 22G needle would require insertion of a 0.018-inch guidewire, the stiffness of which is less than that of the 0.025-inch guidewire.This could result in a longer procedure time, because the 0.018-inch guidewire needs to be exchanged for a 0.025-inch guidewire for the insertion of various devices.Recently, a novel 0.018-inch ultra-stiff guidewire (J-Wire Premier NM, J-MIT, Shiga, Japan) has become available in Japan ( Fig. 1).This guidewire is made of a titanium, nickel, and cobalt alloy, and the sheath material is coated with polytetrafluoroethylene.The enhanced stiffness of this guidewire allows device insertion without the need to exchange the guidewire.Herein, we describe EUS-HGS using this guidewire.A 59-year-old man, who had undergone pancreaticoduodenectomy because of pancreatic head cancer 3 years earlier, was admitted to our hospital due to complications of hepaticojejunostomy stricture and obstructive jaundice.EUS-HGS was attempted.Since the diameter of the intrahepatic bile duct was 1 mm on EUS imaging ( Fig. 2), a 22G needle was selected.Contrast medium was injected E-Videos Fig. 1 A novel 0.018-inch ultra-stiff guidewire made of a titanium, nickel, and cobalt alloy, with a sheath material coated with polytetrafluoroethylene.