Novel fine gauge electrocautery dilator for endoscopic ultrasound-guided biliary drainage: experimental and clinical evaluation study (with video)

Endoscopic ultrasound-guided biliary drainage (EUS-BD) has emerged as an alternative drainage technique for endoscopic retrograde cholangiopancreatography (ERCP) 1 . EUS-BD can be divided into two main categories. The first category is the transduodenal route, for example, EUS-guided choledochoduodenostomy (CDS). The second is transgastric, for example, EUS-guided hepaticogastrostomy (HGS). In addition, EUS-guided gallbladder drainage (GBD) can be performed from both routes. Among these procedures, technical tips can be divided into four steps. The first category is puncturing the biliary tract. The second is guidewire insertion, followed by tract dilation. The final step is stent deployment. Successful tract dilation is the most important among these steps. To date, various techniques have been reported for tract dilation including graded, balloon, or electrocautery dilation 2 3 4 . To prevent bile leakage during EUS-BD, a simple dilation technique may be used. The electrocautery dilation technique can certainly dilate the biliary or luminal wall; however, bleeding may occur around the dilation site due to its burning effects. To overcome this, we have developed a novel fine gauge electrocautery dilator device 5 . An experimental study was performed before clinical use of this novel electrocautery dilator. In this technical view, we describe the results of our experimental study and some technical tips for tract dilation in EUS-BD using this novel electrocautery dilator.