FIGURE LEGENDS
FIGURE 1 The clinical course until the first endoscopic retrograde cholangiopancreatography (ERCP). (A) Common bile duct (CBD) stones (arrow) were detected in Magnetic resonance cholangiopancreatography. (B) In addition to CBD stones (arrow), distal CBD stricture (arrow head) was observed by endoscopic cholangiography. (C) After cholangiography, endoscopic sphincterotomy was performed. (D, E) A covered self-expandable metallic stent was placed to dilate the distal CBD stricture after the pancreatic stent was inserted to prevent post-ERCP pancreatitis.
FIGURE 2 The covered self-expandable metallic stent (CSEMS) used in this case was the BONASTENT M-intraductal. The shape of the stent resembles a dumbbell. By pulling a string, the BONASTENT M-intraductal becomes narrower. Therefore, the CSEMS is easy to remove.
FIGURE 3 The findings of the second endoscopic cholangiography. (A) No common bile duct (CBD) stones were observed. (B) After the covered self-expandable metallic stent was removed, the biliary sludge was removed by a balloon catheter. c It was confirmed that the stricture of distal CBD was improved to some extent (arrow head).