Transpapillary biliary drainage using a forward-viewing endoscope for distal malignant biliary obstruction after placement of a duodenal stent for type I duodenal stenosis

Transpapillary biliary drainage using a side-viewing duodenoscope is widely performed for patients with obstructive jaundice. In patients with pancreaticobiliary cancer, both distal malignant biliary obstruction (MBO) and duodenal stenosis may be complicated ([Fig. 1]) [1], and it is often difficult to insert the duodenoscope in patients with duodenal stenosis on the oral side of the major papilla, especially. Endoscopic ultrasound-guided biliary drainage and percutaneous transhepatic biliary drainage are useful as alternative procedures; however, the presence of ascites or collateral flow makes it impossible to perform these procedures. We report a case of transpapillary biliary drainage for MBO using a forward-viewing endoscope after placement of a duodenal stent for type I duodenal stenosis.