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CC BY 4.0 · Journal of Digestive Endoscopy 2025; 16(01): 046-048
DOI: 10.1055/s-0045-1805003
Endoscopy Video

Maldeployed Hepaticogastrostomy Stent—Rescue by a Novel Technique (with Video)

Pankaj Gupta
1   Institute of Liver and Gastrointestinal Sciences, Max Super Speciality Hospital, New Delhi, India
,
Vikas Singla 
1   Institute of Liver and Gastrointestinal Sciences, Max Super Speciality Hospital, New Delhi, India
,
Pankaj Singh
1   Institute of Liver and Gastrointestinal Sciences, Max Super Speciality Hospital, New Delhi, India
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Abstract

A 69-year-old female with pancreatic head malignancy with obstructive jaundice and duodenal bulb infiltration underwent endoscopic ultrasound (EUS)-guided hepaticogastrostomy (HGS). During stent placement, proximal end of the metal stent got maldeployed inside the peritoneal cavity along with loss of guidewire access. Multiple attempts to cannulate the proximal end of stent through the puncture site were unsuccessful. Considering the morbid nature of potential surgical option, a novel EUS-guided rescue technique was performed. Body of previously maldeployed stent was identified with EUS examination and was punctured with 19 G needle (transgastric route) followed by guidewire negotiation in common hepatic duct. Sequential dilatation of gastric puncture site and stent was performed. A fully covered self-expandable metallic stent was placed with the distal end in previously maldeployed stent and the proximal end inside gastric lumen and free flow of bile could be established. The present case highlights that stent maldeployment can be a serious complication during EUS-HGS, which can occur even in expert hands. Loss of proximal end in the peritoneal cavity may lead to a challenging situation, which may be rescued by puncture of the maldeployed stent with the placement of additional stent.

Keywords

EUS - hepaticogastrostomy - maldeployed stent


Publication History

Article published online:
19 March 2025

© 2025. The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution License, permitting unrestricted use, distribution, and reproduction so long as the original work is properly cited. (https://creativecommons.org/licenses/by/4.0/)

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  • References

  • 1 Ochiai K, Fujisawa T, Ishii S. et al. Risk factors for stent migration into the abdominal cavity after endoscopic ultrasound-guided hepaticogastrostomy. J Clin Med 2021; 10 (14) 3111
    CrossrefPubMedSearch in Google Scholar
  • 2 Martins FP, Rossini LG, Ferrari AP. Migration of a covered metallic stent following endoscopic ultrasound-guided hepaticogastrostomy: fatal complication. Endoscopy 2010; 42 (Suppl. 02) E126-E127
    Thieme ConnectPubMedSearch in Google Scholar
  • 3 Hamada T, Nakai Y, Isayama H, Koike K. Tandem stent placement as a rescue for stent misplacement in endoscopic ultrasonography-guided hepaticogastrostomy. Dig Endosc 2013; 25 (03) 340-341
    CrossrefPubMedSearch in Google Scholar