GI Endoscopy · 1 min read
Stent Delivery Device with Transparent Inner Guiding Catheter and How to Place a Plastic Stent into the Bile Duct
Experienced teaching points
Clinical Pearls
- Using a plastic stent delivery system with a transparent inner guiding catheter allows the endoscopist to visually track the guidewire during insertion, eliminating the strict necessity for fluoroscopy during stent deployment.
- During stent delivery, the endoscopist must maintain focus on the radio-opaque marker of the inner guiding catheter while advancing the pusher tube; simultaneously, the assistant must maintain tension by 'pulling' the inner guiding catheter to keep the marker stable.
- Once the stent is fully inserted into the bile duct, create a 'V' angle between the stent and the pusher tube; this angle holds the stent in place while the assistant smoothly withdraws the inner guiding catheter and guidewire for final deployment.
Professor of Medicine, Virginia Tech Carilion School of Medicine, Virginia, USA; Universidad de la República, Uruguay; PD at University Otto-von-Guericke, Germany; UEES, Universidad Espiritu Santo, Guayaquil, Ecuador; University of Belgrade, Belgrade, Serbia; J. Strossmeyer University, Osijek, Croatia
Effective and successful ERCP is based on skills, knowledge, and devices. Often, simple devices make a huge difference in success. Herein we present such a device and dwell into the art of inserting a plastic stent into the biliary tract.
Figure 1. Plastic Stent delivery device with transparent inner guiding catheter.
The plastic Stent delivery device with transparent inner guiding catheter (Figure 1, Figure 2) is a nice innovation in ERCP. The simple idea of making a transparent inner guiding catheter, which goes over the biliary guidewire is quite ingenious, as it allows for direct endoscopic visualization during insertion and stent placement (Figure 1E and Figure 2Cyellow oval). By watching the guidewire through the inner guiding catheter when pushing the plastic stent, no fluoroscopy or x-rays are necessary.
Figure 2. Tips when using the plastic stent delivery device with transparent inner guiding catheter.
How to deliver the plastic stent:
Top tips and tricks on how to place a plastic stent into the bile duct (Figure 3).
1. Focus on the radio-opaque mark of the inner guiding catheter (insert A, green arrows)
2. Unlock (insert B shows handle) the pusher tube (insert A, light blue oval)
3. Advance (push) on the pusher, assistant “pulls” (puts tension on inner guiding catheter, keeping radio-opaque mark in place
4. Once the stent is inside the bile duct, create a “V” angle between stent and pusher tube (yellow arrow, B) and the assistant pulls the inner guiding catheter and guidewire out (deploy, C). Released stent (C, D).
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