Fig. 3. (A) Fluoroscopic view of a pseudocyst obstructing the common bile duct (CBD). (B) A fully-covered self-expandable metallic stent (FC-SEMS) is inserted by endoscopic retrograde cholangiopancreatography (ERCP) method. As there is no actual intrinsic CBD stricture, a double pigtail stents are inserted through FC-SEMS to “anchor”. (C) Endoscopic ultrasound-guided cystogastrostomy. Two guidewires are inserted into the pseudocyst. (D) Two double pigtail stents are inserted into the pseudocyst. (E) Scout film after the procedure. Biliary and cystogastrostomy stents are close each other. It is interesting that the biliary FC-SEMS is fully expanded indicative of significant decompression of the cyst within 30 minutes after the cystogastrostomy. (F) Biliary stents are removed 3 months later. ERCP shows normal cholangiogram.
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