Development of devices for interventional endoscopic ultrasound for the management of pancreatobiliary diseases

Abstract

A variety of devices have been developed for interventional endoscopic ultrasound (EUS). EUS-guided drainage of the bile duct and pancreatic duct, as well as fluid collection adjacent to the gastrointestinal tract, is performed by a procedure involving puncture, guidewire manipulation, tract dilation, and stent placement. Devices specialized for interventional EUS are being developed for each step of the procedure. Mechanical dilators such as bougie, balloon, and electrocautery dilators are used for tract dilation. Various types of plastic stents, selfexpandable metal stents, and lumen-apposing metal stents specifically designed for interventional EUS are now available, including one-step devices developed to improve the efficacy and safety of interventional EUS. In addition, radiofrequency ablation and the placement of fiducial markers and radioactive seeds under EUS guidance are now becoming established for pancreatic neoplasms. Such development of specialized devices has expanded the indications for interventional EUS, increased the success rate, and lowered the adverse event rate.

Safety and efficacy of covered self-expandable metallic stent for choledochojejunal anastomotic stricture: A multi-center retrospective cohort study

“…This is particularly challenging in situations in which repeat endoscopic access to the anastomosis is not feasible, which necessitates careful consideration of CMS placement because of the inability to subsequently remove the stent. In cases DBE insertion into into the anastomosis proves challenging, the endoscopic ultrasound (EUS)-guided approach has recently emerged as a novel method [17]. This technique involves accessing the biliary system from the upper intestine for drainage or management of biliary diseases [18].…”

One‐step tract dilation using a novel long balloon catheter during endoscopic ultrasound‐guided hepaticogastrostomy

“…If tract dilation takes too long or over‐dilation occurs, the risk of biliary peritonitis due to bile leakage increases. Various useful tact dilation devices are now available, including an ultra‐tapered mechanical dilator, a drill dilator, and a cautery dilator, and can be selected depending on the case 1–5 . Recently, a novel balloon catheter (balloon diameter 3 or 4 mm, length 6 cm, REN biliary dilation catheter; Kakea Medix, Osaka, Japan) has been developed for tract dilation in EUS‐HGS (Figure 1).…”

“…Various useful tact dilation devices are now available, including an ultra-tapered mechanical dilator, a drill dilator, and a cautery dilator, and can be selected depending on the case. [1][2][3][4][5] Recently, a novel balloon catheter (balloon diameter 3 or 4 mm, length 6 cm, REN biliary dilation catheter; Kakea Medix, Osaka, Japan) has been developed for tract dilation in EUS-HGS (Figure 1). The tip of this catheter is only 3-F and tapered, and it also has favorable pushability.…”

Endoscopic Ultrasound Biliary Drainage in Pancreatic Cancer

“…The uncovered segment allows for stent anchorage within the biliary tree, avoiding the occlusion of small biliary radicles. However, other types of stents have been developed for this indication, and can be used in different regions, depending on their availability, such as tubular SEMSs with a spring-type stopper or a hook structure on the luminal side (Niti-S Spring Stopper Stent; Taewoong Medical; Hook stents; ZEON Medical), or thin tubular SEMSs loaded onto a thin tapered delivery system (HANAROSTENT Benefit; M.I.Tech) allowing for insertion without the need for electrocautery or prior tract dilation [24]. Prior to stent deployment, the correct position of the stent should be checked fluoroscopically.…”