Freehand endoscope exchange (FEE) during EUS-guided biliary rendezvous (EUS-RV): A new tip to avoid guidewire entanglements

Abstract Text EUS-RV involves two limiting-steps: antegrade guidewire passage across the papilla and endoscope exchange, during which friction may result in guidewire dislodgment from the CBD. Periampullary diverticulum resulted in repeated cannulation failure for CBD stones. After 19G EUS-guided CBD puncture, a 0.025”guidewire was passed antegrade into duodenum. The EUS-scope was gently advanced from bulb to 2nd-portion. The distal guidewire-end was retrieved oustide the EUS-scope with a 5F-forceps. Using dual traction, a 7F-plastic stent was placed retrogradelly through the EUS-scope into the CBD across invisible papilla. The EUS-scope was removed freely, a duodenoscope introduced, plastic stent cannulated, and ERCP completed.