Endoscopic multiple metal stenting for the treatment of enteral leaks near the biliary orifice: A novel effective rescue procedure

Figure 1 Fluoroscopy. A: Trans-stent duodenoscopy. Cholangiopancreatography already performed prior to enteral stenting; B: Two guidewires (biliary and pancreatic) inside the biliary and the pancreatic ducts; C: Final fluoroscopic image of a 6 cm × 10 mm biliary SEMS and a 7 Fr × 7 cm plastic pancreatic stent draining inside the enteral stent; D: After 4 wk, the multistent complex was removed endoscopically.

Figure 2 Bilio-enteric external fistula after pancreaticoduodenectomy. A: An 8 mm × 4 cm biliary SEMS was inserted into the common bile duct through the meshes of the enteral SEMS; B: Final stent complex at the end of the procedure; C: Detail of CT scan performed two days after the intervention showing the relationship between the two SEMS (biliary stent protruding inside the enteral).