Ogura Takeshi, Kawai Junichi, Nishiguchi Kyohei, Yamamoto Yoshitaro, Higuchi Kazuhide
2nd Department of Internal Medicine, Osaka Medical College, Osaka, Japan.
Dig Endosc. 2022 Jan;34(1):234-237. doi: 10.1111/den.14121. Epub 2021 Sep 10.
Recently, endoscopic ultrasound (EUS)-guided biliary drainage has been developed as an alternative biliary drainage technique for failed endoscopic retrograde cholangiopancreatography (ERCP) or inaccessible papilla. Among the various EUS-guided biliary drainage procedures, EUS-guided hepaticogastrostomy (HGS) can be performed in patients with surgically altered anatomy. More recently, various transluminal treatments have been described after EUS-HGS, such as antegrade stone removal. In patients with hepaticojejunostomy strictures, stone extraction into the intestine might be challenging even after performing hepaticojejunostomy stricture dilation using a balloon catheter. In such cases, transluminal stone removal is considered an alternative method. With transluminal stone removal, a small stone that escapes from the conventional basket or from a balloon catheter could migrate into the branch bile ducts. The novel spiral basket catheter available in Japan. The wires form a helix shape, wherein each wire is wound counterclockwise, and the winding pitch becomes gradually tighter from the proximal portion to the tip. As the winding pitch is smaller and the wires are in closer contact with the bile duct wall as compared with conventional basket catheter, small bile duct stones can be easily captured by simply pulling back the catheter while the basket is open. In addition, even during withdrawal inside the bile duct, a high retrieval performance is assured by the special design that maintains the opening width on the top end. Therefore, transluminal stone removal using this novel basket catheter might be clinically useful, although further prospective evaluation of a larger number of cases is needed.
最近，内镜超声（EUS）引导下的胆道引流已发展成为一种用于内镜逆行胰胆管造影（ERCP）失败或乳头难以到达情况的替代胆道引流技术。在各种EUS引导下的胆道引流手术中，EUS引导下的肝胃吻合术（HGS）可用于解剖结构发生手术改变的患者。最近，在EUS-HGS术后描述了各种腔内治疗方法，如顺行取石。对于肝空肠吻合口狭窄的患者，即使使用球囊导管进行肝空肠吻合口狭窄扩张后，将结石排入肠道也可能具有挑战性。在这种情况下，腔内取石被认为是一种替代方法。通过腔内取石，从传统网篮或球囊导管中逃逸的小结石可能会迁移到肝内胆管分支。日本有一种新型螺旋网篮导管。金属丝形成螺旋形状，其中每根金属丝逆时针缠绕，缠绕间距从近端到尖端逐渐变窄。与传统网篮导管相比，由于缠绕间距较小且金属丝与胆管壁接触更紧密，在网篮打开时简单地回撤导管就能轻松捕获小胆管结石。此外，即使在胆管内回撤过程中，其特殊设计能保持顶端开口宽度，从而确保了高取石性能。因此，尽管需要对更多病例进行进一步的前瞻性评估，但使用这种新型网篮导管进行腔内取石可能在临床上有用。
