
==== Front
Endosc Ultrasound
Endosc Ultrasound
EUSJ
Endoscopic Ultrasound
2303-9027
2226-7190
Lippincott Williams & Wilkins

EUSJ_240070
10.1097/eus.0000000000000069
00010
3
Images and Videos
Guidewire technique and nasobiliary duct–assisted secondary EUS-guided biliary drainage
Wu Xiao-Chao 289959046@qq.com
1
Tang Rui-Yi 1623235832@qq.com
1
Wang Fei wangfei880606@126.com
1
Cao Rui-Zhen caoruizhenxh@163.com
2
Jiang Guo-Bin jgb58509932@163.com
1
Miao Lin 1 ∗
Wang Kai-Xuan 3 ∗
1 Medical Centre for Digestive Diseases, The Second Affiliated Hospital of Nanjing Medical University, Nanjing, Jiangsu Province, China
2 Department of Gastroenterology, Ordos Central Hospital, Inner Mongolia Medical University, Ordos, Inner Mongolia
3 Department of Gastroenterology, Changhai Hospital, Second Military Medical University and Naval Medical University, Shanghai, China.
∗ Address for correspondence: Medical Centre for Digestive Diseases, The Second Affiliated Hospital of Nanjing Medical University, Nanjing, Jiangsu Province, China or Department of Gastroenterology, Changhai Hospital, Second Military Medical University and Naval Medical University, Shanghai, China. E-mail: linmiao@njmu.edu.cn or wangkaixuan224007@163.com (L. Miao or K.-X. Wang).
May-Jun 2024
25 6 2024
13 3 196197
21 11 2023
14 3 2024
Copyright © 2024 The Author(s). Published by Wolters Kluwer Health, Inc on behalf of Scholar Media Publishing.
2024
Wolters Kluwer on behalf of Scholar Media Publishing.
https://creativecommons.org/licenses/by-nc-nd/4.0/ This is an open-access article distributed under the terms of the Creative Commons Attribution-Non Commercial-No Derivatives License 4.0 (CCBY-NC-ND), where it is permissible to download and share the work provided it is properly cited. The work cannot be changed in any way or used commercially without permission from the journal.

OPEN-ACCESSTRUE
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pmcA 75-year-old woman was hospitalized for jaundice and high fever. She had undergone Roux-en-Y hepaticojejunostomy because of hilar cholangiocarcinoma 1 year before.

Endoscopic retrograde cholangiopancreatography was performed, but the guidewire failed to pass the stenosis at the origin of the left hepatic duct [Figure 1]. Due to the increasing jaundice, we opted for EUS-guided biliary drainage (EUS-BD), instead of percutaneous transhepatic cholangiography drainage, to relieve biliary obstruction. Segment 2 (B2) was punctured, but the guidewire could not pass through the narrow bilioenteric anastomosis. Gastrointestinography showed the anastomosis was linearly narrow and angulated [Figure 2]. The fistula was dilated with a 6F coaxial electric cautery (Cysto-gastro-set; ENDO-FLEX, Voerde, Germany) and then with a 7F biliary dilation catheter (Soehendra biliary dilation catheter; Cook Medical, Bloomington, IN) that penetrated into the abdominal cavity; localized contrast medium was observed on plain x-ray. A single-pigtail nasobiliary drainage tube was inserted to relieve biliary leakage [Figure 3]. The abdominal perforation resolved 5 days later. The guidewire was inserted through the nasobiliary duct, passed through the bilioenteric anastomosis, and coiled in the intestinal cavity [Figure 4]. Rendezvous procedure was performed successfully. The nasobiliary tube was cut using scissor forceps, and the distal part was placed into the gastric cavity, as a modified plastic stent [Figure 5]. Bilirubin decreased fast, and the patient was discharged a week later without adverse events.

Figure 1 The guidewire failed to pass the stenosis at the origin of the left hepatic duct during endoscopic retrograde cholangiopancreatography procedure.

Figure 2 EUS-BD was performed; the anastomosis was linearly narrow and angulated.

Figure 3 Localized contrast medium was observed on plain x-ray; a single-pigtail nasobiliary drainage tube was inserted.

Figure 4 The guidewire was inserted through the nasobiliary duct, passed through the bilioenteric anastomosis, and coiled in the intestinal cavity.

Figure 5 The nasobiliary tube was cut using scissor forceps, and the distal part was placed into the gastric cavity, as a modified plastic stent.

This is the first reported case of guidewire technique and nasobiliary duct–assisted secondary EUS-BD. The patient experienced complications in EUS-BD for the first time. After the symptoms improved, we followed the nasobiliary duct to adjust the guidewire. The second EUS-BD EUS-Rendezvous (EUS-RV) was successfully completed. The nasobiliary duct was used as a modified plastic stent for EUS-Hepaticogastrostomy (EUS-HGS). It is to be hoped our case can help you get inspiration.

Acknowledgments

None.

Conflicts of Interest

The authors declare that they have no financial conflict of interest with regard to the content of this report.

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.

Author Contributions

Xiao-Chao Wu, Rui-Yi Tang, and Fei Wang participated in the acquisition, interpretation, and in the manuscript drafting. Rui-Zhen Cao and Guo-Bin Jiang provided imaging guidance. Lin Miao contributed to the conception. Kai-Xuan Wang revised the manuscript for important intellectual content. All authors reviewed the manuscript.

Published online: 25 June 2024

Xiao-Chao Wu, Rui-Yi Tang, and Fei Wang contributed equally to this work.
