Needle-free technique for guidewire manipulation during endoscopic ultrasound-guided pancreatic duct drainage

Endoscopic ultrasound-guided pancreatic duct drainage (EUS-PD) is considered if the pancreatic duct approach under endoscopic retrograde cholangiopancreatography guidance is unsuccessful due to failure of pancreatic duct cannulation or an inaccessible papilla [1] [2] [3]. During EUS-PD, guidewire manipulation may be one of the limiting steps, especially in nonexpert hands [4]. Guidewire manipulation may fail due to the guidewire shearing against the needle. During EUS-guided hepaticogastrostomy, to prevent guidewire shearing, the liver impaction technique can be attempted [5]; however, during EUS-PD, the short length of pancreatic parenchyma on the puncture route may render this technique challenging. To overcome this, technical tips for a needle-free technique during EUS-PD are described.