Technical outcomes between a drill dilator and ultra-tapered mechanical dilator during EUS-guided...

Endoscopic ultrasound-guided pancreaticogastrostomy (EUS-PGS) is performed for patients who have failed ERCP. Tract dilation is one of the challenging procedural steps during EUS-PGS. Recently, a bougie dilator, the drill dilator, has become available. With this device, tract dilation can be easily performed without pushback of the echoendoscope, allowing stable scope positioning to be achieved during tract dilation. However, comparative studies between ultra-tapered mechanical and drill dilators have not been reported. The aim of this study was to compare the technical outcomes of these dilation devices.

Symptomatic patients with main pancreatic duct (MPD) strictures from January 2021 to November 2023 were included in this retrospective study. The technical success rate of tract dilation was first evaluated. Overall technical success rate, procedure time, and adverse events were evaluated as secondary outcomes.

The technical success rate of initial device insertion into the MPD was higher with the Tornus ES (100%, 12/12) compared with the ES dilator (60%, 9/15) ( P =0.013). Additional tract dilation rate to deploy the stent was needed in 86.7% (13/15) in the ES dilator group, and 8.3% (1/12) in the Tornus group ( P =0.001) and the overall technical success rate in the Tornus ES group was 100% (12/12). Mean procedure time was shorter in the Tornus ES group (13.38±3.80 min) compared with the ES dilator group (21.40±1.54 min) ( P =0.0013).

In conclusion, Tornus ES might be considered as the initial dilation device during EUS-PGS.