Usefulness of Rapid Exchange<sup>TM</sup> Locking Device (RELD) in multiple stents insertion in endoscopic biliary drainage

The case was a 68-year-old woman. Jaundice appeared in mid-October 2002 and admitted on November 7th. Ultrasound (US) and CT scan revealed dilatation of the intrahepatic bile ducts, and endoscopic retrograde cholangiography (ERC) was performed. With diagnosis of bile duct cancer at the porta hepatis, endoscopic nasobiliary drainage (ENBD, 6Fr) was placed in the right intrahepatic bile duct. Since jaundice was scarcely reduced in spite of ENBD, drainage of bile ducts on both sides was also considered necessary, and placement of stents in multiple bile ducts was attempted on November 19th. Jagwire was placed in the left bile duct with TJF, and endoscopic sphincterotomy (EST) was performed. The bile duct was then dilated by balloon inflation, and jagwire was fixed to RELD (Microvasive®) . The second jagwire was inserted into the right intrahepatic bile duct, and the first endoscopic retrograde biliary drainage (ERBD, 7Fr/10cm) was inserted and retained. The second ERBD (7Fr/10cm) was subsequently inserted into the left intrahepatic bile duct by the use of jagwire fixed to RELD and retained. Reduction of jaundice proceeded well after that. On December 2nd, hilar bile duct resection was performed. Patient was discharged on day 45 of illness, and under observation currently. In multiple stents insertion in endoscopic biliary drainage, RELD ensured accurate insertion of the stent by fixing the guidewire and preventing its slippage. RELD was thus considered useful in endoscopic procedures such as one used in the present case.