Endoscopic ultrasonography-guided choledochoduodenostomy without tract dilation using a novel ultra-tapered slim-delivery metallic stent.

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Several techniques for endoscopic ultrasonography-guided choledochoduodenostomy (EUS-CDS) without tract dilation have been reported to reduce the risk of bile leakage [ 1 ] [ 2 ] [ 3 ] [ 4 ]. However, bile leakage may still occur, particularly when the insertion of the stent delivery system is challenging. A novel self-expandable metallic stent (SEMS) with a 7-Fr slim delivery system (Niti-S EUS-BD system End Bare Single Flare; Taewoong Medical Co., Ltd., Gimpo, South Korea) features an ultra-tapered tip designed for use with a 0.025-in guidewire ([ Fig. 1 ]). Its cross-wire structure provides a high radial force that minimizes the risk of stent migration. Herein, we present a case of EUS-CDS performed without tract dilation using this novel SEMS ([ Video 1 ]). Fig. 1 A novel self-expandable metallic stent with a 7-Fr slim delivery system (Niti-S EUS-BD system End Bare Single Flare; Taewoong Medical Co., Ltd., Gimpo, South Korea) featuring an ultra-tapered tip that minimizes the gap with a 0.025-in guidewire. Download A novel ultra-tapered slim-delivery metallic stent was used to perform endoscopic ultrasonography-guided choledochoduodenostomy without the need for tract dilation in a 64-year-old woman with unresectable pancreatic cancer, biliary obstruction, and liver metastasis.Video 1 A 64-year-old woman with unresectable pancreatic cancer complicated by biliary obstruction was admitted to our hospital. Computed tomography revealed multiple metastases in the left liver lobe ([ Fig. 2 ]). Initial transpapillary biliary drainage was attempted, but the guidewire could not be passed through the stricture. EUS-CDS was subsequently performed. A dilated common bile duct was punctured using a 19-gauge Franseen needle (TopGain; Medi-Globe GmbH, Grassau, Germany), and a 0.035-in guidewire was introduced. An attempt was made to insert a fully covered SEMS with an 8-Fr delivery system, but the tip of the system was unable to pass through the bile duct wall. Fig. 2 Computed tomography of a 64-year-old woman with unresectable pancreatic cancer and biliary obstruction (arrowheads) revealed liver metastasis in the left lobe. A tapered catheter was then inserted, and the guidewire was exchanged for a 0.025-in version (VisiGlide 2; Olympus Medical Systems, Tokyo, Japan). Utilizing the ultra-tapered tip and the 7-Fr slim delivery system, the novel SEMS (8-mm diameter, 10-cm length) was advanced smoothly into the bile duct without the need for tract dilation. The stent was successfully deployed from the left hepatic duct to the duodenum ([ Fig. 3 ]). The patient recovered uneventfully and was discharged without adverse events. Fig. 3 Endoscopic ultrasonography-guided choledochoduodenostomy. a The dilated common bile duct was punctured using a 19-gauge Franseen needle. b A fully covered metallic stent with an 8-Fr delivery system could not pass through the bile duct wall. c The novel metallic stent with an ultra-tapered tip and 7-Fr slim-delivery system was smoothly advanced into the bile duct. d The metallic stent was placed successfully. To the best of our knowledge, this is the first reported case of EUS-CDS performed without tract dilation using a novel SEMS with an ultra-tapered slim delivery system. This simple approach offers a safe technique for EUS-CDS. Endoscopy_UCTN_Code_TTT_1AS_2AD Endoscopy E-Videos https://eref.thieme.de/e-videos E-Videos is an open access online section of the journal Endoscopy , reporting on interesting cases and new techniques in gastroenterological endoscopy. All papers include a high-quality video and are published with a Creative Commons CC-BY license. Endoscopy E-Videos qualify for HINARI discounts and waivers and eligibility is automatically checked during the submission process. We grant 100% waivers to articles whose corresponding authors are based in Group A countries and 50% waivers to those who are based in Group B countries as classified by Research4Life (see: https://www.research4life.org/access/eligibility/ ). This section has its own submission website at https://mc.manuscriptcentral.com/e-videos . Publication History Article published online: 18 June 2025 © 2025. The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution License, permitting unrestricted use, distribution, and reproduction so long as the original work is properly cited. (https://creativecommons.org/licenses/by/4.0/). Georg Thieme Verlag KG Oswald-Hesse-Straße 50, 70469 Stuttgart, Germany