Various innovative roles for 3‐Fr microcatheters in pancreaticobiliary endoscopy

Abstract

With the development of newer devices and technical innovations, pancreaticobiliary endoscopy is expanding to assume more advanced therapeutic roles. As with other devices, slimmed-down "3-Fr microcatheters" are considered to be opening new windows toward entirely new therapeutic techniques for various purposes. Our practical experience with a total of 34 consecutive patients in whom 3-Fr microcatheters were applied during pancreaticobiliary endoscopic procedures clarified the potential roles of this instrument in pancreaticobiliary endoscopy. The major benefits of 3-Fr microcatheters involve their slimness and flexibility. Applications of 3-Fr microcatheters could be categorized into three groups according to the characteristics of usage: (1) utilization as a cannulation catheter for peroral digital cholangioscopy (n = 15); (2) selective advancement through deep flexures or severely stenotic ducts (n = 11); or (3) two-devices-in-one-channel technique (n = 8). The microcatheter worked successfully for cannulation of cholangioscopy in all but one case (14/15, 93.3%).For selective advancement, the microcatheter worked for troubleshooting in 9 of 11 cases (81.8%). With the twodevices-in-one-channel technique, the microcatheter proved satisfactory in all cases (8/8, 100%). In total, the microcatheter was successfully maneuvered in 31 of 34 cases (91.1%), following the failure of procedures using conventional endoscopic techniques. In terms of adverse events, cystic duct injury was only observed in two cases (5.8%), who recovered under conservative observation, because its slimness could minimize the damage. We believe that 3-Fr microcatheters offer effective and safe salvage troubleshooting during various endoscopic pancreaticobiliary procedures that face troublesome situations with conventional strategies.

Theoretical step approach with ‘Three-pillar’ device assistance for successful endoscopic transpapillary gallbladder drainage

“…Flex-GW has been designed with an innovative flexible tip portion that allows smooth tracking and easy maneuverability [ 17 ], and is expected to be particularly valuable for advancing through a tortuous cystic duct. 3-Fr Micro was designed to overcome various limitations of the ERCP procedure [ 19 ]. The major benefits of this microcatheter stem from its flexibility and slimness.…”

“…From a strategic perspective, there are several chokepoints in the ETGBD procedure: potential challenges in identifying the cystic duct (CD) on cholangiography, in advancing the guidewire (GW) through an unfavorable angle of the CD or CD tortuosities, and in the case of obstruction of the CD due to calculus or malignancy. In our previously presented studies, including several case reports, we have described the use of three novel devices for troubleshooting difficult ETGBD: 1) cholangioscopy [ 16 ], 2) a new easily maneuverable flex-type GW [ 17 ], and 3) a 3-Fr microcatheter [ 18 , 19 ]. Each device had particular strengths.…”

Combined stent-by-stent and stent-in-stent biliary metal stent deployment using a forward-oblique viewing echoendoscope in surgically altered anatomy

“…After wire-guided biliary cannulation, two 0.025-inch guidewires were placed in the right posterior superior segmental and left hepatic ducts, followed by simultaneous insertion of two 5.4F-diameter delivery systems (ZeoStent V; Zeon Medical, Tokyo, Japan). The posterior stent was subsequently deployed across the stricture, and a 3-Fr microcatheter (Hanako Medical, Saitama, Japan) [3] was introduced over the posterior guidewire, and then the guidewire was advanced into the anterior hepatic duct through the stent mesh. An additional metal stent with a 5.4 F delivery system was inserted without the need for any dilation and deployed in the anterior duct in a SIS manner.…”

A 3-Fr microcatheter is suitable for a 0.018-inch guidewire during endoscopic ultrasound-guided biliary drainage

“…Although the catheter must be inserted into the bile duct across the fistula in a challen-ging situation of this kind, advancing a conventional catheter over a 0.018-inch guidewire can sometimes be difficult because of the gap between the guidewire and the catheter. Here, we report the first use of a new 3-Fr microcatheter that we produced previously [4], which has the following advantages for use with a 0.018-inch guidewire during EUS-BD: (i) it allows easy insertion because of its slimness and flexibility, (ii) it provides a sufficient contrast-filled image, (iii) it as-sists in manipulating the guidewire to advance into the target space, (iv) it avoids unnecessary dilation until needed, and (v) it allows exchange of the guidewire from 0.018-inch to 0.025-inch to provide support for device insertion (▶ Fig. 1).…”