Beware of bile peritonitis caused by kinking of the self-expandable metal stent during endoscopic ultrasound-guided hepaticogastrostomy

Self-expandable metal stents (SEMSs) are often used for endoscopic ultrasound-guided hepaticogastrostomy (EUS-HGS), but bile peritonitis due to stent dislocation or cover breakage can be a serious adverse event [1] [2] [3]. While kinking of the SEMS is occasionally a problem with transpapillary stenting, there have been no reports of kinking of the SEMS in EUS-HGS. Here, we report a case in which a SEMS used in EUS-HGS kinked and caused bile peritonitis ([Video 1]).