Stone extraction balloon-guided repeat self-expanding metal stent placement

Figure 1 Plain film of the abdomen seven days after deploying the second self-expanding metal stent (SEMS). The unexpanded part of the second SEMS due to entanglement (arrows).

Figure 2 Fluoroscopy. The stone extraction balloon (arrow) was advanced distal to the existing SEMS.

Figure 3 Duodenoscopy. A: The stone extraction balloon advancing over the region of tumor ingrowth; B: The guidewire advancing through the stone extraction balloon; C: The expanded covered SEMS.

Figure 4 Plain film of the abdomen seven days after replacement of the SEMS. The fully expanded second SEMS overlapping the first SEMS without entanglement (arrow).