Stent Delivery Device with Transparent Inner Guiding Catheter and How to Place a Plastic Stent into the Bile Duct

Professor of Medicine, Virginia Tech Carilion School of Medicine, Virginia, USA; Universidad de la República, Uruguay; PD at University Otto-von-Guericke, Germany; UEES, Universidad Espiritu Santo, Guayaquil, Ecuador; University of Belgrade, Belgrade, Serbia; J. Strossmeyer University, Osijek, Croatia

Effective and successful ERCP is based on skills, knowledge, and devices. Often, simple devices make a huge difference in success. Herein we present such a device and dwell into the art of inserting a plastic stent into the biliary tract.

Figure 1. Plastic Stent delivery device with transparent inner guiding catheter.

The plastic Stent delivery device with transparent inner guiding catheter (Figure 1, Figure 2) is a nice innovation in ERCP. The simple idea of making a transparent inner guiding catheter, which goes over the biliary guidewire is quite ingenious, as it allows for direct endoscopic visualization during insertion and stent placement (Figure 1E and Figure 2Cyellow oval). By watching the guidewire through the inner guiding catheter when pushing the plastic stent, no fluoroscopy or x-rays are necessary.

Clinical endoscopic image — **Figure 1.** Plastic Stent delivery device with *transparent inner guiding catheter.*

Figure 2. Tips when using the plastic stent delivery device with transparent inner guiding catheter.

How to deliver the plastic stent:

Top tips and tricks on how to place a plastic stent into the bile duct (Figure 3).

1. Focus on the radio-opaque mark of the inner guiding catheter (insert A, green arrows)

2. Unlock (insert B shows handle) the pusher tube (insert A, light blue oval)

3. Advance (push) on the pusher, assistant “pulls” (puts tension on inner guiding catheter, keeping radio-opaque mark in place

4. Once the stent is inside the bile duct, create a “V” angle between stent and pusher tube (yellow arrow, B) and the assistant pulls the inner guiding catheter and guidewire out (deploy, C). Released stent (C, D).

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About the author

Klaus Mönkemüller, MD, PhD, FASGE, FJGES, FESGE

Editor-in-Chief, The Practicing Endoscopist

Professor of Medicine, Carilion Memorial Hospital / Virginia Tech Carilion School of Medicine, Roanoke, Virginia, USA

Klaus Mönkemüller, MD, PhD, FASGE, FJGES, FESGE, is the editor-in-chief of The Practicing Endoscopist and the founder of EndoCollab. He is Professor of Medicine at Virginia Tech Carilion School of Medicine and a practicing endoscopist at Carilion Memorial Hospital in Roanoke, Virginia.

Dr. Mönkemüller has published extensively on endoscopic techniques and devices, with a particular focus on therapeutic endoscopy, foreign body removal, GI bleeding, and the use of caps and accessories in everyday practice. He lectures internationally and has contributed to multiple GI endoscopy textbooks and atlases.

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