LAUSR

Endoscopic biliary stenting is a widely accepted method to treat benign and malignant biliary strictures [1, 2]. Multiple plastic stents are recommended for treating benign biliary strictures [3, 4]. However, there is a risk of inward migration of a previously placed stent during insertion of the subsequent stent owing to interference of the stent in the biliary stricture. In the case of surgically altered anatomy in particular, few suitable devices are available to remove a migrated stent from an inward bile duct, and it is difficult to recover the situation [5]. Therefore, it is necessary to prevent inward stent migration when placing multiple stents. Here, we report a prophylactic technique to place multiple plastic stents safely and reliably in a patient with a surgically altered anatomy (▶Fig. 1). A 77-year-old man with a Roux-en-Y reconstruction was diagnosed with obstructive jaundice (▶Fig. 2). He was scheduled to undergo endoscopic biliary stenting using an enteroscope. After the ampulla of Vater had been reached, we inserted two guidewires across the stricture and placed the first straight-type plastic stent, leaving the guidewire in E-Videos