A novel long-balloon dilator for endoscopic ultrasound-guided hepaticogastrostomy and bridging stenting with partial stent-in-stent method

Endoscopic ultrasound-guided hepaticogastrostomy (EUS-HGS) is useful for the drainage of malignant hilar biliary obstructions [1] [2]. The partial stent-in-stent (pSIS) method using the HGS route is helpful for draining the separated right intrahepatic bile duct; however, it is challenging because of long, tight bile duct strictures and difficulty in passing delivery systems through the stent mesh [3]. A novel balloon dilator ([Fig. 1]) with a tapered tip and long dilation portion has recently become available in Japan. This report describes successful implementation of the pSIS method for hilar stenting of the right anterior bile duct (RAD) and right posterior bile duct (RPD) via the HGS route using such a novel long-type balloon dilator ([Video 1]).