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Editorial A novel spiral dilator for pancreatic duct drainage: catching two birds with one stone
Han Taek Jeongorcid, Jimin Han,orcid

DOI: https://doi.org/10.5946/ce.2024.201
Published online: September 2, 2024

Division of Gastroenterology, Department of Internal Medicine, Daegu Catholic University School of Medicine, Daegu, Korea

Correspondence: Jimin Han Division of Gastroenterology, Department of Internal Medicine, Daegu Catholic University School of Medicine, 33 Duryugongwon-ro 17-gil, Nam-gu, Daegu 42472, Korea E-mail: jmhan@cu.ac.kr
• Received: July 27, 2024   • Revised: July 29, 2024   • Accepted: July 30, 2024

© 2024 Korean Society of Gastrointestinal Endoscopy

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (https://creativecommons.org/licenses/by-nc/4.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

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See the article "Safety and efficacy of endoscopic ultrasound-guided pancreatic duct drainage using a drill dilator: a retrospective study from Japan".
Endoscopic ultrasound-guided pancreatic duct drainage (EUS-PDD) is an alternative technique that can be used when endoscopic retrograde pancreatography is not successful or feasible for patients with pancreatic duct obstruction or obstruction. Either rendezvous or transmural approaches can be utilized. Multiple studies,1-3 reviews,4-6 and a meta-analysis7 have been published on this method; Most of these studies used balloon catheters for tract dilatation. The technical success of EUS-PDD is quite high at 81.4% when performed at tertiary referral centers by experienced endoscopists.7 However, many endoscopists agree that the most challenging part of EUS-PDD is the dilatation of the tract and subsequent stent placement.
In this issue of Clinical Endoscopy, Sadek et al.8 introduced the use of a novel drill dilator for EUS-PDD in patients with impaired pancreatic drainage. A total of 12 patients (11 with pancreaticojejunostomy anastomotic stricture and one with pancreatitis) were included in this retrospective analysis. The Tornus ES dilator (Asahi Intec), which is available in two sizes (compatible with 0.018- and 0.0.25-inch guidewires). Since the shaft of the dilator is made of a coil sheath, the clockwise turning of the dilator enables the tract dilation to 7 Fr without much exertion. On the other hand, the counterclockwise turning of the dilator results in the dilator removal.
The success of EUS-PDD when using the novel dilator was similar to results from previously reported studies using other bougie or balloon dilators.1-7 This dilator was used for both fistula and anastomotic stricture. When tract dilation was inadequate for either (for a fistula or an anastomotic stricture), the authors switched to a different Tornus ES dilator or balloon dilator additionally. The results were very promising, with a median procedure time of 24 minutes and a technical success rate of 100%. Majority of fistula dilatations were achieved with the Tornus ES dilator, with only two patients (16.7%) requiring an additional balloon dilator. Contrastingly, dilatation of the anastomotic strictures was achieved with the Tornus dilator in only 4 of 11 patients (36.3%); the remaining seven (63.6%) required an additional balloon dilator. Adverse events were reported in two of 12 patients (16.7%) who experienced low-grade fever that lasted for 1 day and resolved after a course of antimicrobial agent. No procedure-related pancreatitis, bleeding, or pancreatic juice leakage was observed.
The use and safety of the Tornus ES dilator in EUS-guided hepaticogastrostomy had already been investigated.9 The current study by Sadek et al.8 expanded the applications of this tool to EUS-PDD. As the authors pointed out, tract dilation to 7 Fr was “very easily” done with the Tornus ES dilator, and stricture dilation was also successful. The total procedure time was acceptably short (13–52 minutes). The sample size was relatively small but understandable accounting for the novelty of the dilator and the low prevalence of patients requiring EUS-PDD. Additionally, because the current study was conducted at a single center, ease of use and maneuverability should be reproduced by other endoscopists in different centers. Long-term outcomes of patients and the use of a dilator for revision are also interesting topics to address in future research. Overall, this novel drill dilator appears to be safe and effective for use on fistulas and anastomotic strictures.
  • 1. Oh D, Park DH, Cho MK, et al. Feasibility and safety of a fully covered self-expandable metal stent with antimigration properties for EUS-guided pancreatic duct drainage: early and midterm outcomes (with video). Gastrointest Endosc 2016;83:366–373.ArticlePubMed
  • 2. Kahaleh M, Hernandez AJ, Tokar J, et al. EUS-guided pancreaticogastrostomy: analysis of its efficacy to drain inaccessible pancreatic ducts. Gastrointest Endosc 2007;65:224–230.ArticlePubMed
  • 3. Kurihara T, Itoi T, Sofuni A, et al. Endoscopic ultrasonography-guided pancreatic duct drainage after failed endoscopic retrograde cholangiopancreatography in patients with malignant and benign pancreatic duct obstructions. Dig Endosc 2013;25 Suppl 2:109–116.ArticlePubMed
  • 4. Chapman CG, Waxman I, Siddiqui UD. Endoscopic Ultrasound (EUS)-guided pancreatic duct drainage: the basics of when and how to perform EUS-guided pancreatic duct interventions. Clin Endosc 2016;49:161–167.ArticlePubMedPMCPDF
  • 5. Imoto A, Ogura T, Higuchi K. Endoscopic ultrasound-guided pancreatic duct drainage: techniques and literature review of transmural stenting. Clin Endosc 2020;53:525–534.ArticlePubMedPMCPDF
  • 6. Ogura T, Ohama H, Higuchi K. Endoscopic ultrasound-guided pancreatic transmural stenting and transmural intervention. Clin Endosc 2020;53:429–435.ArticlePubMedPMCPDF
  • 7. Bhurwal A, Tawadros A, Mutneja H, et al. EUS guided pancreatic duct decompression in surgically altered anatomy or failed ERCP: a systematic review, meta-analysis and meta-regression. Pancreatology 2021;21:990–1000.ArticlePubMed
  • 8. Sadek A, Hara K, Okuno N, et al. Safety and efficacy of endoscopic ultrasound-guided pancreatic duct drainage using a drill dilator: a retrospective study from Japan. Clin Endosc 2024;57:666–674.Article
  • 9. Okuno N, Hara K, Haba S, et al. Novel drill dilator facilitates endoscopic ultrasound-guided hepaticogastrostomy. Dig Endosc 2023;35:389–393.ArticlePubMedPDF

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