ASGE DDW Videos from Around the World | 2026-CROSSING THE UNCROSSABLE- USE OF A NOVEL DRILL DILATOR FOR DIFFICULT BILIARY STRICTURES

CROSSING THE UNCROSSABLE- USE OF A NOVEL DRILL DILATOR FOR DIFFICULT BILIARY STRICTURES

Video Transcription

Video Summary

A novel torque-driven dual dilator was introduced for difficult biliary strictures during ERCP. Unlike standard catheters, it advances by clockwise rotation through a helical tip, requiring minimal push and working with 0.018- and 0.025-inch guidewires. In three challenging cases—primary sclerosing cholangitis, recurrent PSC after liver transplant, and ischemic cholangiopathy with Roux-en-Y anatomy—the device successfully crossed tight or angulated strictures after conventional dilators failed. It enabled subsequent balloon dilation and stenting without adverse events, improving drainage and liver tests. The report suggests this device may be a useful rescue tool in complex ERCP cases.

Asset Subtitle

Endoscopy in Action
Submitted by Hyun Jae Kim

Keywords

torque-driven dual dilator

biliary strictures

ERCP

guidewire dilation

rescue device