Endoscopic ultrasound-guided antegrade dilation using a drill dilator for hepaticojejunostomy stricture with cholangioscopic findings.

In obstructive jaundice due to hepaticojejunostomy stricture (HJS), drainage has been performed by endoscopic ultrasound-guided hepaticogastrostomy (EUS-HGS) [1] [2] [3]. Various techniques have been reported for dilation of the HJS site, including antegrade balloon dilation, self-expandable metal stent deployment, and electrocautery dilation. However, these procedures have the disadvantages of insufficient efficacy, high cost, and risk of bleeding, respectively. A novel drill dilator has recently become available in Japan (Tornus ES; Asahi Intecc, Aichi, Japan) ([Fig. 1]) [4]. This device enables the tract to be easily dilated using a clockwise rotation without using pushing force. We herein describe successful dilation for HJS, with cholangioscopic findings.