Endoscopic ultrasound-guided hepaticogastrostomy stent exchange using a novel spiral plastic stent

Endoscopic ultrasound-guided hepaticogastrostomy (EUS-HGS) can be attempted for patients with failed endoscopic retrograde cholangiopancreatography [1] [2]. EUS-HGS has recently become indicated for not only malignant biliary obstruction, but also benign biliary disease [3] [4]. In benign biliary disease, a self-expandable metal stent (SEMS) might not be suitable, because stent removal may be challenging if the duration of stent deployment is prolonged. Therefore, a plastic stent is usually used. According to a previous study, regular stent exchange may have a clinical impact on prevention of benign biliary disease [4]. However, flaps are provided at the distal end in most plastic stents to prevent stent dislocation. Unlike the common bile duct, the intrahepatic bile duct has side branches; therefore, during stent removal, the flaps may become stuck in the side branches. Consequently, a plastic stent with flaps has a risk of rupture, as previously described [5].