# Gastroptosis as a Risk Factor of Stent Migration After Endoscopic Ultrasound‐guided Hepaticogastrostomy: A Case Report

## TL;DR

This case report shows that gastroptosis, an abnormal stomach position, can cause stent migration after a specialized biliary drainage procedure.

## Contribution

The paper identifies gastroptosis as a novel risk factor for stent migration after EUS-HGS, even when preoperative imaging appears normal.

## Key findings

- Stent migration occurred despite a long stent and acceptable preoperative CT measurements.
- Gastroptosis was identified as a contributing factor during postoperative endoscopy.
- The case suggests that gastroptosis may increase migration risk compared to normal anatomy.

## Abstract

Endoscopic ultrasound‐guided hepaticogastrostomy (EUS‐HGS) has become an established, alternative biliary drainage technique for patients with failed or difficult endoscopic retrograde cholangiopancreatography. Stent migration is a particularly serious adverse event of this method. To minimize the risk of migration, preoperative computed tomography (CT) may be used to confirm the distance between the stomach and the liver. We herein report a rare case of stent migration that occurred despite the use of a long stent. Although preoperative CT demonstrated an acceptable hepaticogastric distance, pronounced gastroptosis involving an excessive, downward extension of the stomach during esophagogastroduodenoscopy on postoperative day 3 led to stent migration. This case highlights the importance of recognizing gastroptosis as a potential risk factor of stent migration following EUS‐HGS.

Gastroptosis may be associated with a higher risk of stent migration than non‐gastroptotic anatomy.