21g chiba needle

Both bare and covered stents were inserted under the fluoroscopic guidance. The methods of bare and covered stents insertion were same. A 21G Chiba needle (Cook, Bloomington, IN) was punctured into the intrahepatic biliary tract via the right approach. The contrast-medium was injected into the biliary tract to confirm the DMBO site and the length of obstruction. A 4F angiographic catheter (Cordis, Warren, FL) with a 0.035-inch normal guide wire (Terumo, Tokyo, Japan) was then employed to pass through the obstruction. When the catheter and guide wire entered the duodenum, a 0.035-inch stiff guide wire (Cook) was used to replace the normal guide wire. The stent introducer sheaths were sent to the DMBO site via the stiff guide-wire and the stents were released to recanalize the obstruction.
All patients were placed an 8.5F temporary biliary drainage catheter (Cook) and administered preventive anti-inflammatory medications and hemostasis for 5 days.

All procedures were performed using fluoroscopic guidance and all patients underwent unilateral stenting. Stent diameter and length were 8 mm and 50 to 70 mm. The right intrahepatic biliary tract was punctured using a 21G Chiba needle (Cook) under fluoroscopic and ultrasonic guidance. Obstructions were visualized using cholangiography. The extent of any obstruction was evaluated using a 4F VER catheter (Cordis, FL) and a 0.035-in. guide wire (Terumo, Tokyo, Japan). Once the catheter and guide wire were inserted past the obstruction, the guide wire was replaced with a 0.035-in. stiff guide wire (Cook), which was used to release the stent at the obstructed site.

The basic equipment used included a biliary puncture sleeve (including a 21 G Chiba needle, a 0.018-inch platinum microguidewire, a three-piece dilator, a 9-F dilation tube, a 0.035-inch reinforced guidewire, an 8.5-F internal and external drainage tube, and an external fixation device; Cook Medical, Bloomington, IN, USA), a 0.035-inch ultrasmooth guidewire (Terumo, Tokyo, Japan), an Amplatz ultra-stiff guidewire, a 5-F Cobra contrast catheter, and 6.0-mm biopsy forceps (Micro-Tech, Nanjing, China). All procedures were carried out under the guidance of DSA.