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Updated: Nov 25, 2025

Endoscopic Ultrasound-Guided Biliary Drainage: Endoscopic Ultrasound-Guided Hepaticogastrostomy in Malignant Biliary Obstruction
Published on: March 25, 2022
Use of a double-lumen cytology brush catheter to allow double-guidewire technique for endoscopic interventions
Kavel H Visrodia1, Todd H Baron2, Georgios Mavrogenis3
1Division of Gastroenterology, Massachusetts General Hospital, Boston, Massachusetts.
Background And Aims:
Serial stent placement may be necessary during endoscopic interventions, but the passage of a guidewire alongside an initial stent can be challenging, time-consuming, and sometimes unsuccessful. We describe a modification of a cytology brush catheter to allow simultaneous placement of 2 guidewires to facilitate serial stent placement and demonstrate its application in different scenarios.
Methods:
This is a retrospective series of 3 patients with different conditions (acute cholecystitis, pancreas pseudocyst, and severe biliary stricture) in whom placement of a second guidewire facilitated serial stent placement. A step-by-step demonstration of the technique is provided.
Results:
Serial stent placement was successful in all patients without adverse events.
Conclusions:
A modified cytology brush catheter can be used to deliver 2 guidewires simultaneously during ERCP and EUS procedures. This technique may improve procedural efficiency, maintain a safety track, and augment therapy in certain situations.
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