LAUSR

In obstructive jaundice due to hepaticojejunostomy stricture (HJS), drainage has been performed by endoscopic ultrasound-guided hepaticogastrostomy (EUS-HGS) [1–3]. Various techniques have been reported for dilation of the HJS site, including antegrade balloon dilation, self-expandable metal stent deployment, and electrocautery dilation. However, these procedures have the disadvantages of insufficient efficacy, high cost, and risk of bleeding, respectively. A novel drill dilator has recently become available in Japan (Tornus ES; Asahi Intecc, Aichi, Japan) (▶Fig. 1) [4]. This device enables the tract to be easily dilated using a clockwise rotation without using pushing force. We herein describe successful dilation for HJS, with cholangioscopic findings. An 80-year-old woman who had undergone pancreatoduodenostomy for pancreatic head cancer 1 year previously was admitted to our hospital with obstructive jaundice. Although there was no sign of recurrence of pancreatic cancer, obstructive jaundice due to HJSwas observed.We therefore performed EUS-HGS with antegrade dilation at the site of HJS using a balloon catheter, with stent exchange scheduled in 3 months’ time. The endoscopic retrograde cholangiopancreatography (ERCP) catheter was inserted into the biliary tract through the EUSHGS route, and contrast medium was injected. However, the HJS could not be sufficiently treated (▶Fig. 2) because the ERCP catheter could not be advanced across the HJS site into the intestine (▶Fig. 3). Therefore, we attempted antegrade dilation using the drill dilator, which was successful (▶Fig. 4). The cholangioscope was inserted into the HJS site to check for adverse events following the procedure and confirmed sufficient dilation with no bleeding (▶Fig. 5). Finally, a plastic stent was deployed (▶Video 1). In conclusion, EUS-guided antegrade dilation for HJS using the drill dilator appears to be effective and safe. Further evaluation is necessary to confirm these findings.