A 75-year-old woman presented at an external hospital for the evaluation of painless jaundice and significant weight loss. Initial imaging raised suspicion of a pancreatic head carcinoma with duodenal infiltration. Endoscopic retrograde cholangiopancreatography (ERCP) performed externally was unsuccessful due to duodenal stenosis, likely secondary to tumor obstruction. An endoscopic ultrasound (EUS) -guided transduodenal puncture of the distal common bile duct (CBD) was performed with the placement of a fully covered self-expandable metal stent (FCSEMS). However, the stent was inadvertently deployed entirely within the CBD without creating a fistulous tract – resulting in intraductal maldeployment with persistent cholestasis. The duodenal puncture site was closed with two hemoclips. The patient was then referred to our center. Access to the papilla was again not possible due to tumor-related duodenal obstruction. We proceeded with an EUS-guided choledochoduodenostomy (CDS; Video 1). The distal CBD was punctured transduodenally using a 19G needle (Fig. 1). After contrast injection, a 0. 025-inch guidewire was inserted and advanced intrahepatically under fluoroscopic guidance, bypassing the maldeployed FCSEMS (Fig. 2). A 6 × 8 mm electrocautery-enhanced lumen-apposing metal stent was successfully deployed, resulting in immediate biliary drainage (Fig. 3). Five days later, a scheduled reintervention was performed. A therapeutic gastroscope with a transparent hood was advanced to the lumen-apposing metal stent (LAMS), and a 10 Fr cholangioscope was introduced through the LAMS into the CBD. Under direct visualization, the previously maldeployed FCSEMS was identified. Using cholangioscopic biopsy forceps, the stent was grasped at its distal flange and successfully retrieved under direct visualization through the LAMS and the working channel of the endoscope (Fig. 4 and Fig. 5). This case demonstrates the utility of EUS-guided CDS not only for decompression, but also as a secure access route for advanced intraductal interventions such as cholangioscopic stent rescue – especially in cases where conventional ERCP is not feasible. EndoscopyUCTNCodeCPL₁AK₂AD Article published online: 17 February 2026 © 2026. The Author (s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution License, permitting unrestricted use, distribution, and reproduction so long as the original work is properly cited. (https: //creativecommons. org/licenses/by/4. 0/). Georg Thieme Verlag KG Oswald-Hesse-Straße 50, 70469 Stuttgart, Germany
Freund et al. (Tue,) studied this question.