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DOI: 10.1055/a-2271-4215
Efficacy of a novel drill dilator in overcoming severe biliary strictures with balloon enteroscopy
In patients with altered anatomy, biliary strictures are widely overcome using balloon enteroscopy-assisted endoscopic retrograde cholangiopancreatography (BE-ERCP). As the balloon enteroscope has a small-diameter channel and scope maneuverability is poor, severe biliary strictures are often difficult to overcome. In such cases, dilation has previously been achieved using screw-type stent retrievers [1] [2]. Recently, however, a novel drill dilator (Tornus ES; Asahi Intecc Co., Ltd., Aichi, Japan) has been developed specifically for penetrating and dilating strictures [3] [4] [5].
Case 1: A woman aged in her 60s, with liver metastasis after subtotal stomach-preserving pancreaticoduodenectomy (SSPPD) for pancreatic head cancer presented with cholangitis due to a severe malignant stricture in the left hepatic bile duct ([Fig. 1]). Attempts to place a plastic stent using a balloon enteroscope (SIF-H290S, Olympus Co., Tokyo, Japan) were challenging because of the extreme hardness of the stricture. Despite trying another dilator, only a catheter was able to pass through. The novel drill dilator easily traversed and dilated the stricture, allowing for successful stent placement ([Fig. 2], [Video 1]).
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Case 2: A man aged in his 70s experienced cholangitis with intrahepatic biliary obstruction due to recurrence of distal bile duct cancer after SSPPD. It was determined that the obstruction in the posterior branch, where stenting had not been successful, was the main cause of cholangitis. The stricture was very tight and significantly angulated, making it impossible to traverse with any devices under BE-ERCP ([Fig. 3]). The rotational force and adequate flexibility of the novel drill dilator enabled the stricture to be successfully traversed and dilated, followed by successful stent placement ([Fig. 4], [Video 1]).
In BE-ERCP, where the range of usable devices and maneuverability are limited, the novel drill dilator proved to be useful in dilating severe biliary strictures, even in patients with altered anatomy.
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Publication History
Article published online:
08 March 2024
© 2024. The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution License, permitting unrestricted use, distribution, and reproduction so long as the original work is properly cited. (https://creativecommons.org/licenses/by/4.0/).
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References
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