Endoscopic ultrasound‐guided rendezvous with a combination of 22‐gauge needle and 0.018‐inch guidewire for acute cholangitis with Cronkhite‐Canada syndrome
Bibliographic record
Abstract
E NDOSCOPIC ULTRASOUND-GUIDED RENDEZ- VOUS (EUS-RV) is an effective salvage technique for unsuccessful cannulation.1-4 Although a 19-gauge needle is usually used, non-dilated duct puncture is difficult because of its large caliber and stiffness.5 We demonstrate that EUS-RV with a 22-gauge needle and 0.018-inch guidewire could access the non-dilated bile duct, where puncture using a 19gauge needle is difficult.A 69-year-old man with Cronkhite-Canada syndrome (CCS) was admitted to our hospital for acute cholangitis due to common bile duct stone (CBDS).Initially, endoscopic retrograde cholangiography (ERC) was attempted to manage CBDS.However, the duodenal papilla could not be identified because of the presence of numerous polyps, which made ERC difficult (Fig 1).Percutaneous transhepatic biliary drainage and interventional EUS via the intrahepatic bile duct (IHBD) were expected to be difficult because the IHBD was only 1 mm in diameter.Therefore, stone removal with EUS-RV via an extrahepatic bile duct (EHBD) was performed.The first EHBD puncture (diameter, 3 mm) with a 19-gauge needle (EZ shot 3plus; Olympus, Tokyo, Japan) was unsuccessful, resulting in contrast medium injection around the EHBD (Fig 2a).Conversely, it was successfully punctured with a 22-gauge needle (EZ shot 3plus, Olympus) through the second duodenum portion.Then, a 0.018-inch guidewire (Nova-Gold, Boston Scientific, Natick, MA, USA) was easily advanced into the duodenum across the papilla.Subsequently, biliary cannulation was performed over the EUSplaced guidewire that was grasped with a biopsy forceps (Radial Jaw 4; Boston Scientific, Marlborough, MA, USA) and pulled back into the accessory duodenoscope channel.Finally, stone removal was successfully achieved.No adverse events were observed (Fig 2b-d, Video S1).In conclusion, a 22-gauge needle, which is characterized by small caliber, could facilitate non-dilated bile duct puncture that is difficult to puncture using a 19-gauge needle.Therefore, EUS-RV using a 22-gauge needle and a 0.018inch guidewire might to be a useful alternative to salvage non-dilated bile duct cases.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.000 | 0.001 |
| Meta-epidemiology (narrow) | 0.001 | 0.000 |
| Meta-epidemiology (broad) | 0.001 | 0.001 |
| Bibliometrics | 0.002 | 0.001 |
| Science and technology studies | 0.001 | 0.001 |
| Scholarly communication | 0.000 | 0.001 |
| Open science | 0.001 | 0.001 |
| Research integrity | 0.003 | 0.003 |
| Insufficient payload (model declined to judge) | 0.002 | 0.001 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".