Unintended deployment of metallic stent and re-stenting

A malignant biliary stricture was treated with a self expanding metallic stent in this 70 year old gentleman (A:green arrow). The stent was mistakenly deployed distal to the stricture, thereby underlining the importance of checking the stent markers before putting the stent in your scope channel, checking the markers on fluoroscope and keeping an eye on the marker on your screen. The latter two are done simultaneously. Contrast injection showed the deployed stent (B: green arrows), the strictured area which was missed (B: red arrows) and the dilated biliary tree (B: yellow arrow). The second stent assembly was maneuvered through the previous stent and across the stricture (C: green arrows) and the second stent was deployed (D: green arrows marking the new second stent and red arrows showing the overlap zone between the new and old stent).