EUS-guided drainage of the gallbladder (EUS-GBD) is an established technique for gallbladder drainage.[123] Although the usefulness of a lumen-apposing metal stent has been widely reported,[45] it is not available in every institution; hence, techniques on how to safely perform EUS-GBD should be available.
Gallbladder puncture using a thin 22-gauge needle for EUS-FNA (22G FNA needle) is a good method to reduce complications such as bile leakage. However, this has not been feasible due to the lack of an appropriate 0.018-inch guidewire compatible with EUS-guided drainage with good X-ray fluoroscopy visibility and maneuverability.
A 68-year-old woman with obstructive jaundice due to pancreatic head cancer was referred to our hospital. Transpapillary biliary drainage with a covered metallic stent (MS) (X-Suit NIR; Olympus, Tokyo) was performed. After the procedure, jaundice improved, but acute cholecystitis occurred.
Percutaneous drainage was contraindicated due to ascites; hence, EUS-GBD was performed. A 22G FNA needle puncture was performed to minimize bile leakage. We used a new 0.018-inch guidewire (18 Fielder; Olympus, Tokyo) with a hydrophilic coating coil tip and a hard core, enabling both the ease of manipulation and the appropriate hardness required for device insertion [Figure 1].
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Figure 1: A new 0.018-inch guidewire with a hydrophilic coating coil tip (surrounded by a circle) and a hard core (arrow part) enabled both the ease of manipulation and the appropriate hardness required for device insertion (18 Fielder; Olympus, Tokyo)
The guidewire was manipulated to the proper location in the gallbladder lumen with good fluoroscopy visibility. After expanding the puncture site to 3 mm with a balloon catheter, the inner sheath of the MS (Niti-S; Taewoong, South Korea) was inserted into the gallbladder with good pushability even though the guide wire was 0.018 inch. Finally, EUS-GBD was successful without any complications [Figure 2 and Video 1].
Figure 2: (a) The guidewire was manipulated to the proper location in the gallbladder lumen with good fluoroscopy visibility. Then, the inner sheath of metallic stent (※) was inserted into the gallbladder with good pushability even though the guide wire was 0.018 inch. (b) EUS-guided drainage of the gallbladder was successful without any complications
This is the first case of EUS-GBD performed with a 22G needle and a novel 0.018-inch guidewire. It is expected that advances in devices like this will continue to be utilized to make EUS-guided drainage safer.
Declaration of patient consent
The authors certify that they have obtained all appropriate patient consent forms. In the form, the patient has given her consent for her images and other clinical information to be reported in the journal. The patient understands that her name and initials will not be published and due efforts will be made to conceal her identity, but anonymity cannot be guaranteed.
Financial support and sponsorship
Nil.
Conflicts of interest
There are no conflicts of interest.
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