Endoscopic ultrasound-guided hepaticogastrostomy improves hilar access using an uneven double-lumen cannula, highlighting effective rescue techniques.
A common challenge in endoscopic ultrasound-guided hepaticogastrostomy (EUS-HGS) is misdirection of the guidewire into the peripheral bile duct instead of the desired hilar direction. This situation, which often occurs with acute puncture angles, complicates the procedure. The uneven double-lumen cannula (UDC) (Uneven Double Lumen Cannula; Piolax Medical, Kanagawa, Japan) is a valuable tool in these cases, enabling successful hilar guidewire placement as a rescue technique known as the "uneven method" [1]. UDCs have two lumen orifices a short (5-mm) or long (30-mm) distance apart. The long-type UDC is particularly useful for hilar guidewire access because its distal tip remains securely in the bile duct, allowing precise proximal orifice repositioning.
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Sato et al. (2025) studied this question.
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