Graded marking on a pigtail plastic stent to prevent migration during EUS- guided hepaticogastrostomy and gallbladder drainage

Single or double pigtail plastic stents are often used in EUS-guided hepaticogastrostomy and gallbladder drainage. The pigtail shape of the distal end of the stent serves to prevent the stent from migrating out of the gastrointestinal tract when stent placement is properly performed. However, during insertion, it is difficult to recognize the position of the pigtail portion because of its straightened shape, and there is a risk of accidentally pushing the stent out of the gastrointestinal tract. Because most pigtail plastic stents cannot be pulled back, they cannot be retrieved once outside the gastrointestinal tract and can cause biliary peritonitis.
To prevent this, the base of the pigtail portion is often marked, but the markings may be missed due to poor visibility of the stent on the endoscopic view caused by bile outflow around the stent and the oblique view of the echoendoscope.
Recently, we have developed a graded marking to prevent over-insertion of the pigtail portion of the stent. This consists of a stripe marking on the distal half of the stent body and a marking on the entire pigtail portion at the distal end. This marking allows for real-time endoscopic recognition of the stent position during insertion and ensures that stent over-insertion is prevented. The usefulness of this device will be shown in the video.