Abstract
An 84-year-old man was treated for recurrent cholangitis caused by mucin derived from a fistula connected to an intraductal papillary-mucinous neoplasm. Owing to the patient’s old age, instead of surgery, endoscopic transpapillary placement of 2 double-pigtail plastic stents was performed. However, the patency gradually shortened. Thus, 4 double-pigtail plastic stents were initially placed but produced no decompression; therefore, a nasobiliary catheter was temporally placed to resolve the cholangitis. The extrahepatic bile duct near the fistula was 24 mm in diameter. A tamponade effect toward the fistula was difficult to achieve by transpapillary placement of a 10-mm-diameter covered self-expandable metal stent (SEMS). Furthermore,
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