Novel drill dilator facilitates endoscopic ultrasound‐guided hepaticogastrostomy

Tract dilation is one of the most difficult stages of endoscopic ultrasound‐guided hepaticogastrostomy (EUS‐HGS), especially for beginners. To overcome this problem, we applied a special dedicated dilator. Herein, we retrospectively evaluate the safety and usefulness of a novel drill dilator in EUS‐HGS. This single‐center retrospective study included 20 consecutive patients who underwent EUS‐HGS with a novel drill dilator. The tip is 0.77 mm, and it becomes 7F at 3 cm from tip. The track is dilated to 7F by simple clockwise rotation. The technical success rate of both initial tract dilation and stent placement was 20/20 (100%). No cases required additional dilation such as balloon or electric cautery. In 13/20 cases (65.0%), EUS‐HGS was performed by beginner endoscopists. Median time required for dilation was 62.5 s (range, 30–144 s). Median procedure time was 13 min (range, 7–25 min). Early adverse events were two cases of mild fever. There was no bile leakage or bleeding. The novel drill dilator appears to be safe and useful for EUS‐HGS. As it is not necessary to press the device strongly, there is no pushback during dilation and the scope position is stable. These characteristics facilitate EUS‐HGS even for beginners. This device may enable the further development and increased dissemination of EUS intervention.