A 0.035-inch labeled guidewire with a smaller measured diameter enables a minimal-dilation plastic stent-based endoscopic ultrasound–guided gallbladder drainage workflow: A two-case report

Endoscopic ultrasound–guided gallbladder drainage (EUS-GBD) is an established alternative for acute cholecystitis in patients unfit for surgery. While cautery-enhanced lumen-apposing metal stents can provide controlled transmural access, their availability is inconsistent across institutions; therefore, plastic stent (PS)–based EUS-GBD remains clinically relevant in selected settings. We report two cases illustrating a wire-centered, PS-based minimal-dilation EUS-GBD workflow using a 0.035–inch–labeled guidewire with a mean outer diameter of 0.71 mm (range, 0.66–0.76 mm). The guidewire was compatible with a 19-gauge needle and may allow same-wire use of a 0.025–inch–compatible balloon dilator, enabling PS delivery with minimal dilation when passage is smooth and limited same-wire balloon dilation as a bailout when resistance is encountered. Case 1 involved an 89-year-old man with moderate acute cholecystitis in whom percutaneous drainage was unsuitable due to ascites and interposed bowel. A 7-Fr, 10-cm PS was deployed after suction and contrast injection using a tapered catheter. Case 2 involved an 80-year-old man with gangrenous cholecystitis who did not improve after percutaneous gallbladder aspiration; stent advancement was resistant and brief same-wire dilation with a 3-mm balloon was performed as a bailout before PS placement. In both cases, CT at 24 hours confirmed appropriate stent position with no CT evidence of bile leakage, and cholecystitis resolved without recurrence or reintervention during 1-year follow-up. This report demonstrates the technical feasibility of a stepwise same-wire troubleshooting strategy using the tested guidewire–balloon combination. These findings should not be interpreted as evidence supporting routine avoidance of tract dilation or implying improved clinical safety, and device compatibility should be verified in accordance with each manufacturer's instructions for use.