Prospective comparison study between 19G needle with 0.025-inch guidewire and 22G needle with novel 0.018-inch guidewire during EUS-guided transhepatic biliary drainage

Background and aim
A novel, improved 0.018-inch guidewire has recently become available. We conducted a prospective study to evaluate the technical feasibility and safety of EUS-BD in patients with insufficient bile duct dilatation using a 22G needle and the new 0.018-inch guidewire.
Method
A 22G needle is used as the puncture needle for intrahepatic bile ducts of diameter <1.5 mm, and a 19G needle is selected for diameters >1.5 mm. As the primary endpoint of the study, the technical success rate of EUS-BD using a 22G needle with the novel 0.018-inch guidewire was evaluated.
Result
A total of 41 patients who required EUS-BD were enrolled (22G, n=18; 19G, n=23). Technical success was obtained in all patients in the 19G needle group. In the 22G needle group, technical failure occurred in two patients due to non-identification of the intrahepatic bile duct on EUS. Mean procedure time was similar between the groups. Adverse events were observed in 16.7% (3/16) of patients in the 22G needle group, and in 34.8% (8/23) in the 19G needle group.
Conclusions
Use of a 22G needle with a novel 0.018-inch guidewire was comparable to a 19G needle with 0.025-inch guidewire.