ArticleVideoGIE : an official video journal of the American Society for Gastrointestinal Endoscopy2026
A torque-driven drill dilator to enable Y-configuration biliary stent placement for high-grade hilar obstruction.
Article in VideoGIE : an official video journal of the American Society for Gastrointestinal Endoscopy, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Authors and funding
5 authors.
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Abstract
Background and Aims: Endoscopic management of malignant hilar biliary obstruction is technically challenging, particularly with high-grade strictures. Dual-sector metal stent placement using a stent-in-stent (Y) configuration may be preferred to allow durable, suprapapillary, re-accessible drainage. However, traversing the mesh of the first stent into the second sector with dilating catheters can be challenging. A newly available spiral drill dilator (Tornus ES; Asahi Intecc Co, Aichi, Japan) can be used in such cases. Methods: A 74-year-old woman with Bismuth type IIIa cholangiocarcinoma presented with biliary obstruction and underwent endoscopic retrograde cholangiopancreatography for dual-sector, uncovered metal stent placement in a Y configuration. After a left-sector uncovered metal stent was placed, the right anterior hepatic duct was accessed but could not pass the balloon catheter. A drill dilator was then advanced with clockwise rotation. Results: The drill dilator enabled successful stricture passage and creation of a tract through the mesh of the first stent, permitting placement of a second uncovered metal stent in a Y configuration. Conclusions: This case demonstrates the utility of a newly available spiral drill dilator for enlarging the pathway through the mesh of a single metal stent to place a second metal stent for Y-configuration dual-sector biliary drainage.
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Registered trials
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