Preoperative bilateral drainage for perihilar cholangiocarcinoma via endoscopic ultrasound-guided hepaticogastrostomy using a novel side-hole plastic stent

Preoperative bilateral drainage for perihilar cholangiocarcinoma via endoscopic ultrasound-guided hepaticogastrostomy using a novel side-hole plastic stent Fig. 1 a The novel plastic stent (ADFlap, Century Medical, Tokyo, Japan) is equipped with double flaps to prevent migration.b The stent has a tapered tip, with a flap located at the distal 4 cm and two side holes, enabling bile drainage through both the tip and side holes. Fig. 2 Computed tomographic (CT) images showed bile duct wall thickening and upstream biliary dilatation, leading to the diagnosis of bismuth type 3a perihilar cholangiocarcinoma.a Axial view.b Coronal view.c Schema based on CT findings.