Endoscopic ultrasound-guided choledochoduodenostomy using a novel, ultra-stiff, high-sliding guidewire and a dumbbell-shaped metal stent

Endoscopic ultrasound-guided choledochoduodenostomy (EUS-CDS) has potential as a first-line drainage method for malignant distal biliary obstruction. Several randomized controlled trials revealed that EUS-CDS with lumen-apposing metal stent (LAMS) have higher technical success rates and shorter procedure times than conventional transpapillary drainage [1] [2]. However, thin 6-mm diameter LAMSs are frequently used due to their larger flanges, and these stents are associated with adverse events such as biliary wall compression and duodenobiliary reflux, as well as being expensive [3]. Conversely, EUS-CDS using conventional metal stents is associated with a risk of bile leakage due to the need for fistula dilation, as well as stent migration. Herein, we report a new EUS-CDS technique using a novel, ultra-stiff, high-sliding guidewire and a dumbbell-shaped metal stent.