Simultaneous duodenal stenting and endoscopic ultrasound-guided hepaticogastrostomy using a forward-oblique view echoendoscope.

A 65-year old man with advanced pancreatic cancer with a combination of malignant biliary obstruction and gastric outlet obstruction was referred to our hospital. Given the presence of periampullary cancerous lesions, the endoscopic placement of a duodenal stent and endoscopic ultrasound (EUS)-guided hepaticogastrostomy (HGS) were performed simultaneously, using a single convex-array echoendoscope with a forward-oblique view (EG-580T; Fujifilm, Tokyo, Japan; ▶Fig. 1). A partially covered metal duodenal stent (Niti-S COMVI; Taewoong Medical, Gimpo, Korea) was placed under fluoroscopic and endoscopic guidance (▶Fig. 2, ▶Video1). This was followed, without scope exchange, by EUS-HGS: a long partially covered metal stent (modified GIOBOR, Taewoong Medical) was successfully placed [1] from the B3 intrahepatic duct to the stomach under EUS, endoscopic, and fluoroscopic guidance (▶Fig. 3, ▶Video2). The total procedure time was 38 minutes. Combined malignant biliary obstruction and gastric outlet obstruction are not rare in advanced pancreatic cancer and EUS-guided biliary drainage, especially E-Videos