Dilation of a severe biliary stricture by using a guidewire left in place overnight

Endoscopic placement of a biliary stent is frequently used in the treatment and palliation of benign and malig- nant biliary strictures. Dilation of fibrous and tight steno- sis with either a balloon or bougie facilitates stent inser- tion. There is a group of patients in which tight stricture permit passage of only a small caliber guidewire and attempts to dilate with conventional dilators in order to place a stent or nasobiliary drain fail. Using a Soehendra stent retriver or small-caliber angioplasty balloon for dilation and percutaneous or surgical management of the stricture are rescue treatment methods in these patients (1-4). Herein we report the use of a guidewire traversing the stricture and left in place for 24 hours as a dilator in two patients with a severe biliary stricture not traversable by conventional dilators which could be of interest to interventional endoscopists.