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Updated: May 14, 2026
Endoscopic Ultrasound-Guided Biliary Drainage: Endoscopic Ultrasound-Guided Hepaticogastrostomy in Malignant Biliary Obstruction
Published on: March 25, 2022
Feasibility of using wire-guided needle-knife electrocautery for refractory biliary and pancreatic strictures
Dao-jian Gao1, Bing Hu, Ya-min Pan
1Department of Endoscopy, Eastern Hepatobiliary Hospital, Second Military Medical University, Shanghai 200438, China.
Background:
Endoscopic management of biliary or pancreatic strictures by stent insertion is well established. However, some high-grade strictures are refractory to dilation and stent placement with conventional methods.
Objective:
To evaluate the safety and efficacy of the wire-guided electrotomy technique in dilating stiff biliary and/or pancreatic stenoses when ordinary methods failed.
Design:
Retrospective analysis of a prospective database.
Setting:
Tertiary referral university hospital.
Patients:
This study involved 279 patients with biliary or pancreatic strictures who underwent ERCP for stenting.
Intervention:
After conventional dilation failed, wire-guided needle-knife electrocautery was attempted to facilitate insertion of the dilating devices and eventually endoprosthesis.
Main Outcome Measurements:
The successful treatment and drainage of biliary or pancreatic strictures.
Results:
With wire-guided needle-knife cauterization, the success rate of stricture dilatation increased from 95.7% (267 of 279 patients) to 98.9% (276 of 279 patients). Dilation of stenoses was successful in 9 of 10 patients (90%) by using electrocautery with the wire-guided needle-knife technique. Postprocedure adverse events included self-limited bleeding, mild acute pancreatitis, hyperamylasemia, cholangitis, and biliary perforation. No procedure-related death occurred.
Limitations:
Retrospective, single-center study and small sample size.
Conclusions:
Wire-guided needle-knife electroincision appears to be effective for traversing refractory biliary or pancreatic strictures and can be considered as an alternative approach to conventional methods. However, the safety of such a technique needs to be further evaluated.
