Endoscopic ultrasound-guided stent-in-stent placement for management of migrated hepaticogastrostomy stent

Stent misdeployment or migration into the peritoneal cavity is a dreaded complication of endoscopic ultrasound (EUS)-guided hepaticogastrostomy. It occurs in around 2.5 % procedures, is potentially fatal, and usually treated surgically [1]. A few cases have been reported in which this complication was managed by repositioning the stent using transluminal endoscopic surgery techniques [2] [3] or by EUS-guided stent-in-stent insertion [4] [5]. Here we present a case of EUS-guided puncture of the migrated stent through the wall of the gastroesophageal junction followed by stent-in-stent insertion.