Technique for Safe Repositioning of Duckbill-Type Laser-Cut Anti-Reflux Metal Stents Using a Biliary Dilatation Balloon

PresentationAn 86-year-old woman with distal cholangiocarcinoma (Fig.1a) initially underwent plastic stent placement but developed cholangitis 3 days later.To ensure prolonged patency, a duckbill-type anti-reflux metal stent (D-ARMS; 10 mm, 7 cm; Duckbill Biliary Stent; SB-Kawasumi Laboratories, Inc, Tokyo, Japan) was placed; however, the distal end was misplaced, leading to migration (Fig.1b, c).Fifteen days later she was readmitted with cholangitis due to intrahepatic bile duct obstruction at the hepatic hilum caused by the migrated stent (Fig.2a).The D-ARMS is a laser-cut metallic stent that adheres firmly to the bile duct due to its zigzag