Efficacy of a newly developed dilator for endoscopic ultrasound-guided biliary drainage

Figure 1 Newly developed dilator, ES Dilator^® (Zeon Medical Co. , Tokyo, Japan), characterized by high pushability and lesser difference in diameters of the inner lumen and the guidewire. A: Tip of the ES Dilator; B: The ES Dilator has a lesser difference between the diameter of the inner lumen and that of the guidewire (upper figure), compared with traditional tapered catheters for ERCP (lower figure). ES Dilator: Endoscopic ultrasound-guided drainage; ERCP: Endoscopic retrograde cholangiopancreatography.

Figure 2 Technique of endoscopic ultrasound-guided choledochoduodenostomy. A: The extrahepatic bile duct is punctured by a 19-gauge needle under EUS guidance; B: After contrast medium is injected, a guidewire is inserted; C: The puncture tract is dilated with a tapered catheter, a balloon dilator, and/or ES Dilator; D and E; A plastic stent (D) or a metal stent is deployed at the puncture site (E). EUS: Endoscopic ultrasound.