Simultaneous bridging and antegrade stent-in-stent placement via endoscopic ultrasound-guided hepaticogastrostomy using novel multi-hole metal stents

Fig. 4 Bridging and antegrade stent-in-stent placement under EUS-HGS guidance.a After deployment of the first multi-hole metal stent as a bridging stenting, the guidewire is manipulated through a side hole toward the common bile duct.b The guidewire is advanced across the stricture, followed by 6-mm balloon dilation of both the side hole and the stricture.c The second multi-hole metal stent is deployed as an antegrade stent through the side hole of the first stent.d A 7-Fr plastic stent is finally placed through the hepaticogastrostomy tract.EUS-HGS, endoscopic ultrasound-guided hepaticogastrostomy.