Modified technique for deployment of a lumen-apposing metal stent during endoscopic ultrasound-guided choledochoduodenostomy in minimally dilated duct

Electrocautery-enhanced lumen-apposing metal stent (EC-LAMS) has been routinely used for endoscopic ultrasound (EUS)-guided choledochoduodenostomy (CDS) with high technical and clinical success [1]. One of the major factors that determines technical success is common bile duct (CBD) diameter. CBD size < 15 mm is associated with a high risk of technical failure and maldeployment of the distal flange [2] [3]. Correct deployment of the distal flange inside the CBD is one of the most crucial steps of the procedure and, in cases of a marginally dilated duct, there is little space for opening of the distal flange, which increases the risk of maldeployment.