Technical tips for guidewire deployment during EUS-guided hepaticoenterostomy

Abstract

In endoscopic ultrasound-guided biliary drainage (EUS-BD), the typical procedural steps include: (1) puncturing the bile duct, (2) placement of a guidewire, (3) dilation of the puncture tract, and (4) stent placement. Among these steps, the success rate of bile duct puncture, tract dilation, and stent placement have significantly improved due to development of puncture needles, dilation devices, and stents. However, the development of guidewires specifically suitable for EUS-BD remains insufficient. In particular, EUS-guided hepaticoenterostomy (EUS-HES) is considered as one of the most technically challenging to deploy guidewire, because of the small diameter and complex anatomy of the intrahepatic bile ducts. This paper provides an overview of guidewire insertion techniques in EUS-HES, with a focus on technical aspects.