Endoscopic ultrasound-guided hepaticogastrostomy (EUS-HGS) is the standard endoscopic procedure for biliary obstructions [1] [2]. Although various complications such as migration, perforation, and abdominal peritonitis have been reported after EUS-HGS [3] [4] [5], the reintervention method for them has not been established. Herein, we present a case of successful reintervention for a migrated stent after EUS-HGS using a dual-channel endoscope and grasping forceps.

An 88-year-old man with pancreatic cancer underwent EUS-HGS for malignant biliary obstruction, and a partially covered self-expandable metallic stent (SEMS) was placed on the B3 branch. The patient had a high fever 2 days after EUS-HGS. Computed tomography (CT) revealed free air in the abdominal cavity ([Fig. 1]), which was caused by the shifting of the uncovered part of the SEMS to the gastric side by respiratory fluctuation. A reintervention for additional stent placement was urgently performed. A dual-channel endoscope (GIF-2TQ260M; Olympus, Tokyo, Japan) was inserted into the EUS-HGS site. A guidewire was then advanced through the EUS-HGS stent into the right hepatic duct ([Video 1]). However, the catheter could not advance through the B3 branch due to its strong bend. The EUS-HGS stent was too long, poorly anchored, and was difficult to align with the axis; therefore, it could not transmit force in the direction of the catheter ([Fig. 2]). Grasping forceps inserted from the other channel grasped and pulled the stent ([Fig. 3]), after which the catheter and stent delivery system advanced through the bend of the B3 branch by counter-traction ([Fig. 4]). The fully covered SEMS (Boston Scientific, Marlborough, Massachusetts, USA) was then deployed through the stent to the proximal B3 branch ([Fig. 5]). After 1 week, CT showed the disappearance of free air and the biliary metallic stent in the appropriate position. Stent placement using a dual-channel endoscope and grasping forceps may be considered a useful treatment for stent complications after EUS-HGS.

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Article published online:
25 November 2022

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