LAUSR

Stent migration into the abdominal cavity, one of the most serious procedural complications of endoscopic ultrasoundguided hepaticogastrostomy (EUS-HGS) [1], usually requires emergency surgery [2, 3]. No endoscopic troubleshooting technique for stent migration into the abdominal cavity with EUS-HGS has been established to date. Herein, we describe a safe and innovative rescue method for this complication. The patient was a 60-year-old man with duodenal stenosis and biliary obstruction, for which he had undergone bile duct and duodenal stent placement. He developed obstructive jaundice due to stent misplacement; hence, EUS-HGS was performed (▶Video 1). A small quantity of ascites was also present. Puncture was performed from B2 using a 19G needle, and an 8-mm×8-cm fully covered self-expanding metallic stent (FCSEMS; NIR Stent) was placed by the double-wire method. After the stent released, it could not be found inside the stomach, and radiography and EUS showed that it had migrated into the abdominal cavity (▶Fig. 1). An unsuccessful attempt at additional stent placement was made, and the guidewire also slipped out. To recover from themigration, a puncture wasmade aiming at themetal stent inside the intrahepatic bile duct, and a guidewire was inserted from the stent side into the stent lumen and bile duct (▶Fig. 2). After blunt dilatation of the cell part of the metal stent with a catheter, an 8-mm× 8-cm FCSEMS was additionally inserted