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A 70-year-old woman who had undergone endoscopic placement of multiple stents for hilar biliary obstruction due to gallbladder cancer was admitted with cholangitis. In her previous hospitalization, endoscopic ultrasound-guided hepaticogastrostomy (EUS-HGS) had been performed for the bile duct at segment III (B3) using a partially covered self-expandable metal stent (SEMS; modified Giobor, 10×80mm; Taewoong Medical Inc., Gimpo, Korea [1]). To manage subsequent episodes of cholangitis, two uncovered SEMSs were placed via the transpapillary route for B7 and B8 in a partial stent-in-stent fashion (▶Fig. 1). On this admission, endoscopic drainage was scheduled to manage segmental cholangitis in B8. In the first session, transpapillary biliary drainage of B8 failed as a cannula could not be passed through the mesh wall of the indwelling SEMS (▶Fig. 2 a). Therefore, we attempted to access B8 though E-Videos

Transverse stent placement for hilar malignant biliary obstruction through an endoscopic ultrasound-guided hepaticogastrostomy route