The use of a rescue stent in the management of lumen-apposing metal stent migration during EUS-directed transgastric ERCP with stent-in-stent technique to remove a forgotten metal biliary stent

Abstract

Roux-en-Y gastric bypass poses a unique set of challenges during ERCP. Conventional approaches include laparoscopic-assisted ERCP and balloon-assisted enteroscopy. Laparoscopic-assisted ERCP is invasive and requires coordination between a surgeon and gastroenterologist. Balloon-assisted ERCP has a lower procedural success rate (60%-80%),1 and the size of the working channel can limit interventions. EUS-directed transgastric ERCP (EDGE) (Fig. 1)2 allows for a same-day or multistep procedure by creating a gastrogastric fistula, allowing endoscopic access to the biliary tree via the excluded stomach.