Fig. 2.

Endoscopic photo obtained following endoscopic retrograde cholangiopancreatography in a 61-year-old woman with locally advanced pancreatic cancer and high-grade biliary obstruction which required use of the double guidewire technique. To prevent pancreatitis and augment flow of pancreatic secretions, a 5-Fr, single pigtail pancreatic duct stent (arrowhead) is placed, followed by deployment of the uncovered metal biliary stent. Dark bile is seen draining through the braided wire of the metal biliary stent (arrow). When velocity is constant, a 10-mm metal stent allows roughly 10 times more bile flow, in comparison to a 10-Fr plastic stent of the same length.