Efficacy of an easy loop-forming guidewire in endoscopic transpapillary gallbladder drainage with gallstones impacted in the cystic duct

Efficacy of an easy loop-forming guidewire in endoscopic transpapillary gallbladder drainage with gallstones impacted in the cystic duct Endoscopic transpapillary gallbladder drainage (ETGBD) is a drainage method for acute cholecystitis; it is often used in patients who are on antithrombotic drugs or in those presenting with ascites [1-3]. However, the success rate of the procedure is lower than that of percutaneous transhepatic biliary drainage (PTGBD), and one of the reasons for this is the difficulty of inserting the guidewire into the gallbladder Especially in cases where a stone is impacted in the cystic duct, it becomes even more difficult to insert the guidewire into the gallbladder The patient was taking two antithrombotic drugs. Computed tomography revealed gallbladder wall thickening, gallstones, and fatstranding around the enlarged gallbladder ( Fig. Magnetic resonance cholangiopancreatography confirmed the presence of impacted gallstones in the cystic duct ( Fig. Because of the antithrombotic drugs and the presence of ascites, ETGBD was selected as the drainage method. After biliary cannulation, it was not possible to advance a 0.025-inch angled-shape guidewire through the gallstones impacted in the cystic duct and into the gallbladder. Therefore, manipulation using a guidewire that readily forms into a loop shape (J-Wire Prologue; J-MIT, Shiga, Japan) was attempted. This is a 0.025inch guidewire with a soft section as long as 160 mm; the nitinol core is tapered toward the tip, so that it tends to form a loop shape ( Fig. This characteristic allowed a loop shape to be easily created, moving the gallstones impacted in the cystic duct to create a gap, so that the guidewire could be passed into the gallbladder ( Fig. Finally, an endoscopic nasobiliary drainage tube was successfully placed ( Fig. This loop-friendly characteristic is expected to be an effective option in ETGBD for acute cholecystitis with gallstones impacted in the cystic duct.