case_images: PMC10498695_01
case_images: (a) Abdominal computed tomography scan showing an infiltrative spread of poorly demarcated soft tissue shadows in the hilar region and around the common bile duct. The intrahepatic bile ducts are clearly dilated. (b) Bile duct stenosis can be seen from the hilar region to the middle part of the common bile duct, with no passage of the contrast medium to the duodenum. (c) The dedicated plastic stent is placed.
case_images: 10.1177_2050313X231200290-fig1.jpg
case_images: PMC10498695_02_10.1177_2050313X231200290-fig1.jpg
case_images: fig1-2050313X231200290
case_images: The cholangiogram revealed stenosis from the hilar region to the middle part of the common bile duct, and the contrast medium could not pass to the duodenum (Figure 1(b)). K. K., Tokyo, Japan; Figure 1(c)).   Notably, the pigtail-shaped end of the stent on the gastric side has a strong anchoring effect; hence, theoretically, unlike SEMS, the proximal side of the plastic stent cannot migrate into the abdominal cavity.   Moreover, this stent can be easily removed and replaced.
case_images: PMC10498695_02
case_images: (a) Abdominal computed tomography scan showing an infiltrative spread of poorly demarcated soft tissue shadows in the hilar region and around the common bile duct. The intrahepatic bile ducts are clearly dilated. (b) Bile duct stenosis can be seen from the hilar region to the middle part of the common bile duct, with no passage of the contrast medium to the duodenum. (c) The dedicated plastic stent is placed.
case_images: 10.1177_2050313X231200290-fig1.jpg
case_images: PMC10498695_02_10.1177_2050313X231200290-fig1.jpg
case_images: fig1-2050313X231200290
case_images: The cholangiogram revealed stenosis from the hilar region to the middle part of the common bile duct, and the contrast medium could not pass to the duodenum (Figure 1(b)). K. K., Tokyo, Japan; Figure 1(c)).   Notably, the pigtail-shaped end of the stent on the gastric side has a strong anchoring effect; hence, theoretically, unlike SEMS, the proximal side of the plastic stent cannot migrate into the abdominal cavity.   Moreover, this stent can be easily removed and replaced.
case_images: A fully covered self-expandable metallic stent is placed.
case_images: 10.1177_2050313X231200290-fig2.jpg
case_images: PMC10498695_02_10.1177_2050313X231200290-fig2.jpg
case_images: fig2-2050313X231200290
case_images: Tokyo, Japan; Figure 2) 3 months after the initial EUS-HGS.
case_images: Endoscopic procedure performed for reintervention. (a) The stent is completely migrated. However, an EUS-HGS fistula can be seen on the lesser curvature of the stomach wall (white circle). (b) The guidewire is inserted into the bile duct via the EUS-HGS fistula. (c) and (d) The newly dedicated plastic stent is placed via the EUS-HGS fistula.. EUS-HGS: endoscopic ultrasound-guided hepaticogastrostomy.
case_images: 10.1177_2050313X231200290-fig3.jpg
case_images: PMC10498695_02_10.1177_2050313X231200290-fig3.jpg
case_images: fig3-2050313X231200290
case_images: Thus, 4 days after diagnosing cholangitis, the endoscopic procedure was performed again. The side-viewing endoscope (TJF-260V; Olympus Optical, Tokyo, Japan) inserted into the stomach revealed that the stent completely migrated to the gastric side (Figure 3(a)). Finally, the guidewire was successfully inserted into the bile duct through the fistula (Figure 3(b)), and the procedure was completed by placing an antegrade transpapillary stent (Flexima  Plus, 8.5 Fr, 10 cm; Boston Scientific Japan, Tokyo, Japan) and a 7-Fr plastic stent into the fistula (Figure 3(c) and (d)).