Novel technique of additional anchor plastic stent placement during endoscopic ultrasound-guided gallbladder drainage

A fully covered self-expanding metal stent (FCSEMS) is frequently used for endoscopic ultrasound-guided gallbladder drainage (EUS-GBD) in some countries where the use of lumen-apposing metal stent for EUS-GBD is not approved [1] [2]. Coaxial placement of a double-pigtail plastic stent (DPPS) as an anchor within the FCSEMS for EUS-GBD is preferred to prevent food impaction, delayed bleeding, and stent migration [2] [3]. However, placing the additional stent through the distal end of the FCSEMS can be challenging and risky, as the pushing force of the DPPS may be transmitted to an inappropriate axis on the bent portion of the long FCSEMS ([Fig. 1] a). We developed a novel technique to overcome these technical difficulties ([Fig. 1] b).