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A multi-hole self-expandable metal stent with a fine-gauge delivery system (MHCSEMS) is introduced, designed to limit migration via small tissue ingrowths and to reduce pancreatic duct obstruction through side holes. Technical steps using the device are described, with follow-up showing no acute pancreatitis or dislocation.",{"@graph":69,"@context":122},[70,84,105],{"@type":71,"itemListElement":72},"BreadcrumbList",[73,77,79,82],{"item":74,"name":75,"@type":76,"position":8},"https://docshare.wps.com","Home","ListItem",{"item":78,"name":9,"@type":76,"position":14},"https://docshare.wps.com/document/",{"item":80,"name":35,"@type":76,"position":81},"https://docshare.wps.com/document/healthcare/",3,{"item":83,"name":65,"@type":76,"position":19},"https://docshare.wps.com/document/endoscopic-ultrasound-guided-antegrade-transpapillary-multi-hole-self-expandable-metal-stent-with-fine-gauge-stent-delivery-system/459163/",{"url":83,"name":65,"@type":85,"image":86,"author":91,"headline":65,"publisher":94,"fileFormat":97,"inLanguage":63,"description":67,"dateModified":98,"datePublished":99,"encodingFormat":97,"isAccessibleForFree":100,"interactionStatistic":101},"DigitalDocument",{"url":87,"@type":88,"width":89,"height":90},"https://docshare.wps.com/thumbnails/endoscopic-ultrasound-guided-antegrade-transpapillary-multi-hole-self-expandable-metal-stent-with-fine-gauge-stent-delivery-system/459163.png","ImageObject",300,407,{"name":92,"@type":93},"moss~","Person",{"url":74,"name":95,"@type":96},"DocShare","Organization","application/pdf","2026-11-08","2026-09-30",true,{"@type":102,"interactionType":103,"userInteractionCount":29},"InteractionCounter",{"@type":104},"ViewAction",{"@type":106,"mainEntity":107},"FAQPage",[108,114,118],{"name":109,"@type":110,"acceptedAnswer":111},"When is endoscopic ultrasound-guided antegrade stenting (EUS-AS) considered?","Question",{"text":112,"@type":113},"EUS-AS can be performed for patients in whom ERCP is unsuccessful. It is used to manage biliary obstruction when standard access fails.","Answer",{"name":115,"@type":110,"acceptedAnswer":116},"What concerns affect conventional EUS-AS and guide stent selection?",{"text":117,"@type":113},"Key concerns include advancing the stent across the stricture, the risk of acute pancreatitis if the papilla is traversed (since sphincterotomy cannot be performed), and challenges in preventing stent dislocation or migration.",{"name":119,"@type":110,"acceptedAnswer":120},"How does the MHCSEMS design address migration and pancreatic duct obstruction?",{"text":121,"@type":113},"The stent uses multiple small side holes that promote small tissue ingrowths to prevent migration. The side holes also help prevent obstruction of the pancreatic duct.","https://schema.org",{"og:url":83,"og:type":124,"og:title":65,"og:site_name":95,"og:description":67},"article",{"robots":126,"canonical":83},"index,follow",{"doc_id":128,"site_id":62},459163,1790755319,{"code":4,"msg":5,"data":131},{"doc_id":128,"user_id":132,"nickname":92,"user_avatar":133,"doc_module":4,"category_id":34,"category_name":35,"doc_title":65,"doc_description":67,"doc_content":134,"file_id":135,"file_url":136,"file_type":137,"file_size":138,"view_count":29,"is_deleted":4,"is_public":8,"is_downloadable":8,"audit_status":8,"page_count":14,"language":139,"language_code":63,"site_id":62,"html_lang":63,"table_of_contents":140,"faqs":141,"seo_title":142,"seo_description":67,"update_tm":129,"read_time":24,"preview_page_count":4},962090895452,"https://ap-avatar.wpscdn.com/davatar_a8503ba1806abce46bf441b54a3ca4cd","Article published online: 2026-01-08  \nEndoscopic ultrasound-guided antegrade transpapillary multi-hole self-expandable metal stent with fine-gauge stent delivery system  \nEndoscopic ultrasound-guided antegrade stenting (EUS-AS) can be performed for patients in whom endoscopic retrograde cholangiopancreatography (ERCP) is unsuccessful [1–3] . Although EUS-AS has several benefits, including reducing bile leakage from the access route, there are also several concerns. First, stent delivery should be advanced into the biliary tract across the stricture site. Second, if EUS-AS is performed across the papilla, acute pancreatitis should be considered because endoscopic sphincterotomy cannot be performed. Third, to prevent stent dislocation or migration, endoscopic revision may be challenging; therefore, an uncovered metal stent is normally selected, but has limited stent patency. A multi-hole self-expandable metal stent with a finegauge stent delivery system (MHCSEMS; HANAROSTENT Biliary Multi-hole Benefit;  \nM.I. Tech Co., Ltd, Pyeongtaek, South Korea) has been developed to overcome these concerns ( ▶ Fig.1) . The stent is designed to prevent stent migration, through small tissue ingrowths that form in the multiple, small (1 .8-mm) side holes along the covering membrane. The side holes also help prevent obstruction of the pancreatic duct. In addition, because the stent delivery system is only 5.9Fr, it can be advanced easily and smoothly. We describe herein technical tips for EUS-AS using the MHCSEMS.  \nThe dilated intrahepatic bile duct was punctured using a 19G needle, and a 0.025-inch guidewire was inserted. A double lumen dilator was then inserted ( ▶ Fig.2) . Cholangiography identified lower bile duct obstruction as a complication. After performing the double guidewire technique, we attempted to advance the guidewire into the intestine across the papilla ( ▶ Fig.3) . The MHCSEMS stent delivery was then inserted easily ( ▶ Fig.4) . After successful EUS-AS, EUSguided hepaticogastrostomy was performed without any adverse events  \n▶Fig. 1 A multi-hole self-expandable metal stent with a 5.9-Fr stent delivery system (MHCSEMS; HANAROSTENT Biliary Multi-hole Benefit; M.I. Tech Co. , Ltd, Pyeongtaek, South Korea) .  \n▶Fig.2 A guidewire is deployed under endoscopic ultrasound guidance.  \n▶Fig.4 A stent delivery system is inserted across the papilla.  \n▶Fig.3 A double lumen dilator is inserted into the biliary tract.  \n▶Fig.5 Endoscopic ultrasound-guided hepaticogastrostomy is performed.  \nE36 Ogura Takeshi et al. Endoscopic ultrasound-guided antegrade… Endoscopy 2026; 58: E36–E37 | © 2026. The Author(s) .  \nVideo 1 Antegrade transpapillary multi-hole self-expandable metal stent with fine-gauge stent delivery system is performed.  \n( ▶ Fig.5 ; ▶Video 1) . No acute pancreatitis or stent dislocation was observed during follow-up.  \nIn conclusion, EUS-AS using the MHCSEMS with a fine-gauge stent delivery system appears to be a suitable insertion technique that prevents pancreatic duct obstruction and stent dislocation.  \nEndoscopy_UCTN_Code_TTT_ 1AS_ 2AH  \nConflict of Interest  \n\n| The authors declare that they have no conflict of interest.\u003Cbr>The authors |\n| --- |\n| Takeshi Ogura1,2, Jun Matsuno2 , Takafumi Kanadani2, Junichi Nakamura2, Hiroki Nishikawa2\u003Cbr>1 Endoscopy Center, Osaka Medical and Pharmaceutical University Hospital, Osaka, Japan\u003Cbr>2 2nd Department of Internal Medicine, Osaka Medical and Pharmaceutical University, Osaka, Japan\u003Cbr>Corresponding author |\n\nTakeshi Ogura, MD, PhD, FJGES Endoscopy Center, Osaka Medical and Pharmaceutical University Hospital, 2-7 Daigakuchou, Takatsukishi, Osaka 569-8686, Japan  \noguratakeshi041 [1@yahoo.co.jp](1@yahoo.co.jp)  \nReferences  \n[1] Ishiwatari H, Ogura T, Hijioka S et al. EUSguided hepaticogastrostomy versus EUSguided hepaticogastrostomy with antegrade stent placement in patients with unresectable malignant distal biliary obstruction: a propensity score-matched casecontrol study. Gastro","cbCaim4BTLs99Q4i","https://ap.wps.com/l/cbCaim4BTLs99Q4i","pdf",1060668,"English","# Background and Rationale\n## Technical Tips and Procedure Steps\n## Outcomes and Conclusion","[{\"question\":\"When is endoscopic ultrasound-guided antegrade stenting (EUS-AS) considered?\",\"answer\":\"EUS-AS can be performed for patients in whom ERCP is unsuccessful. It is used to manage biliary obstruction when standard access fails.\"},{\"question\":\"What concerns affect conventional EUS-AS and guide stent selection?\",\"answer\":\"Key concerns include advancing the stent across the stricture, the risk of acute pancreatitis if the papilla is traversed (since sphincterotomy cannot be performed), and challenges in preventing stent dislocation or migration.\"},{\"question\":\"How does the MHCSEMS design address migration and pancreatic duct obstruction?\",\"answer\":\"The stent uses multiple small side holes that promote small tissue ingrowths to prevent migration. The side holes also help prevent obstruction of the pancreatic duct.\"}]","Endoscopic ultrasound-guided antegrade transpapillary multi-hole self-expandable metal stent with fine-gauge stent delivery system | PDF"]