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

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.