Acute cholangitis secondary to endoscopic choledochoduodenostomy food impaction

Abstract Text A patient was admitted due to acute cholangitis secondary to endoscopic choledochoduodenostomy (EUS-CDS) food impaction. A cholangioscopy was done through the CDS and an uncovered biliary metal stent was anterogradely deployed through the distal common bile duct stricture into the duodenum. The CDS stent was retrieved but the fistula was maintained patent in case of future potential biliary stent malfunction. Hence, a double-pigtail biliary stent was deployed through the CDS and biliary metal stent, leaving its distal end through the papilla and its proximal end in the duodenal bulb. The diameter of the bulbar CDS fistula was significantly reduced with three clips alongside the proximal end of the plastic stent.