Stent Delivery Device with Transparent Inner Guiding Catheter and How to Place a Plastic Stent into the Bile Duct

By Klaus Mönkemüller, MD, PhD, FASGE, FJGES

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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Images from EndoCollab. See endocollab.com for more information, including videos, quick tips and lectures on these and many other practical endoscopy tricks and techniques.