2019 Volume 95 Issue 1 Pages 135-137
A 75-year-man diagnosed with locally advanced pancreatic cancer underwent biliary stent exchange every 3 months. The latest cholangiography showed hilar stenosis. Bilateral biliary drainage was attempted; however, a plastic biliary stent (PS) could not be advanced to the left hepatic duct. We placed PS in the right and an endoscopic nasobiliary drainage tube in the left intrahepatic duct. Endoscopic ultrasound-guided hepaticogastrostomy (EUS-HGS) was performed a week later to switch from external to internal drainage. We placed 7 Fr PS in the left intrahepatic duct via the transgastric approach. Abdominal radiography performed 2 days after EUS-HGS revealed PS kinking. Therefore, we performed endoscopic transgastric re-intervention and exchanged PS with a self-expandable metallic stent, 9 days after the EUS-HGS. The patient showed good biliary drainage with a favorable clinical course after replacement of the transgastric PS.
