Novel guidewire with coiled tip improves technical success of guidewire manipulation during EUS-guided biliary drainage (with video).

Guidewire insertion and manipulation is a challenging step during EUS-guided biliary drainage.[1] This could be due to guidewire stack by a fine needle.[2] Various efforts to improve the technical success of guidewire manipulation have been reported,[345] although these techniques might be difficult in nonexpert hands. Due to these issues, a novel 0.025-inch guidewire (INAZUMA, Kaneka Medical Corp., Osaka, Japan) has become available in Japan [Figure 1]. The tip of this guidewire is formed by coiling with 70 mm length, which prevents stack by fine needle [Video 1]. We herein describe technical steps for EUS-guided hepaticogastrostomy using this novel guidewire. The intrahepatic bile duct was punctured using a 19G needle (EZ shot; Olympus Medical Systems, Tokyo, Japan), and contrast medium was injected [Figure 2]. Next, the novel guidewire was inserted into the intrahepatic bile duct. However, in cases in which guidewire advancement toward the hepatic hilum is difficult, guidewire torqueing is needed, at which time the guidewire might get stuck. However, since the tip of the novel guidewire is coiled, the guidewire could be advanced into the hepatic hilum without it sticking [Figure 3]. Tract dilation was performed using an ultratapered mechanical dilator (EZ dilator; Zeon Medical, Tokyo, Japan) [Figure 4]. Then, the stent delivery system was inserted into the biliary tract (BileRush Advance, 8 mm × 12 cm, Piolax Medical, Kanagawa, Japan), and stent deployment was subsequently performed from the intrahepatic bile duct to the stomach without any adverse events [Figure 5].Figure 1: The novel 0.025-inch guidewire (Inazuma, Kaneka Medical Corp., Osaka, Japan). The tip of this guidewire is formed by coiling with 70 mm lengthFigure 2: The intrahepatic bile duct was punctured using a 19G needle, and contrast medium was injected to obtain a cholangiogramFigure 3: The novel guidewire was inserted into the biliary tract without sticking off the guidewireFigure 4: Tract dilation was performed using an ultratapered mechanical dilatorFigure 5: Stent deployment from the intrahepatic bile duct to the stomach was performedIn conclusion, the presented novel guidewire might be useful for guidewire insertion or manipulation during EUS-guided biliary drainage, although additional cases and prospective studies are needed to confirm our observations. Financial support and sponsorship Nil. Conflicts of interest Takeshi Ogura is an Editorial Board Member of the journal. The article was subject to the journal’s standard procedures, with peer review handled independently of this editor and his research groups.