Fig. 2.

Stent-in-stent deployment of metallic stents in Bismuth type IV (Bonastent; Standard SciTech Inc.); guidewires were initially introduced into both intrahepatic ducts bilaterally. The first stent with a radiopaque X mark was inserted into the left hepatic duct. After deployment of the first stent, the remaining guidewire was carefully withdrawn using an endoscopic retrograde cholangiopancreatography catheter, without pulling it back completely. The guidewire was then inserted into the right hepatic duct through the central portion of the first stent. Following deployment of the second stent, the bilateral metal stents were in a Y-configuration.