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Many transmural endoscopic devices have been developed for various different procedures; however, few options exist to endoscopically process these indwelling devices once they have been positioned. Here, we introduce a novel technique that allows indwelling devices to be cut endoscopically using a combination of an endoscopic retrograde cholangiopancreatography (ERCP) lithotripter handle and a guidewire, as illustrated in these two patients. The procedure is performed as follows: (i) an ERCP guidewire (VisiGlide 0.025 inch; Olympus, Tokyo, Japan) is inserted through a therapeutic endoscope (GIF-1T240; Olympus) and is looped around the indwelling device using a biopsy forceps (FB-45Q-1; Olympus) (●" Fig.1a); (ii) a lithotripter cable (Conquest TTCL-1; Cook Japan Inc., Tokyo, Japan) is inserted over the guidewire up to the indwelling device (●" Fig.1b); (iii) the guidewire and the cable are connected to the lithotripter handle (Soehendra; Cook Japan Inc.) (●" Fig.1c); (iv) the guidewire is reeled in using the handle, until the tightened loop of the guidewire cuts through the indwelling device (●" Video 1). Fig.1 Photographs showing: a a loop made with the guidewire around the “indwelling” device; b the lithotripter cable inserted over the guidewire; c the guidewire and the cable connected to the handle.

Endoscopic intraluminal cutting technique for indwelling devices using a lithotripter handle and guidewire