EUS-guided antegrade metal stenting with hepaticoenterostomy using a dedicated plastic stent with a review of the literature (with video).

On the other hand, however, there are several disadvantages of EUS-AS+HES compared with EUS-AS alone, as follows: (1) Time-consuming though it may not be significant (only a few minutes), (2) cost increase, in particular in cases of MS placement for HES, (3) risk of MS migration during and/or after EUS-HES due to the shortening of the MS, even in high-volume centers of interventional EUS,[ 20 ] resulting in fatal adverse events,[ 21 ] and (4) possible early stent occlusion due to reflux of residue, in particular in case of large bore MSs.

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