{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,12]],"date-time":"2026-09-12T05:08:20Z","timestamp":1789189700740,"version":"build-2803163510"},"reference-count":6,"publisher":"Wiley","issue":"1","license":[{"start":{"date-parts":[[2026,9,11]],"date-time":"2026-09-11T00:00:00Z","timestamp":1789084800000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"},{"start":{"date-parts":[[2026,9,11]],"date-time":"2026-09-11T00:00:00Z","timestamp":1789084800000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["DEN Open"],"published-print":{"date-parts":[[2027,4]]},"abstract":"<jats:title>ABSTRACT<\/jats:title>\n                  <jats:p>We report an extremely rare case of duodenal bulb perforation caused by a double\u2010pigtail plastic stent placed for walled\u2010off necrosis (WON), coexisting with a biliary fistula to the WON and a choledochoduodenal fistula, all successfully managed with endoscopic treatment alone. A 61\u2010year\u2010old woman developed severe gallstone pancreatitis and underwent endoscopic ultrasound\u2010guided transmural drainage for WON with placement of a lumen\u2010apposing metal stent and a double\u2010pigtail plastic stent. After repeated endoscopic necrosectomy, the metal stent was removed and the plastic stent remained in place. Contrast leakage from the WON into the bile duct was detected, and a biliary stent was inadvertently deployed through a choledochoduodenal fistula. Two hundred thirty\u2010seven days after plastic stent placement, endoscopy revealed a duodenal bulb perforation with purulent discharge. The plastic stent was removed, and the gastric fistula was closed using endoscopic hand\u2010suturing. After spontaneous closure of the stent\u2010induced duodenal perforation was confirmed, the biliary stent placed through the choledochoduodenal fistula was removed and a new stent was inserted through the papilla of Vater, resulting in closure of the choledochoduodenal fistula. Complete closure of all fistulas was confirmed 516 days after the initial hospitalization. This case demonstrates that complex fistulas associated with WON can be successfully treated without surgical intervention.<\/jats:p>","DOI":"10.1002\/deo2.70432","type":"journal-article","created":{"date-parts":[[2026,9,12]],"date-time":"2026-09-12T05:04:41Z","timestamp":1789189481000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Successful Endoscopic Treatment of Walled\u2010Off Necrosis With Complex Quadruple Fistulas Among the Necrotic Cavity, Stomach, Duodenum, and Common Bile Duct"],"prefix":"10.1002","volume":"7","author":[{"given":"Shuhei","family":"Shibata","sequence":"first","affiliation":[{"name":"Department of Gastroenterology Chiba Prefecture Saiseikai Narashino Hospital  Chiba Japan"},{"name":"Department of Gastroenterology Chiba University Hospital  Chiba Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yotaro","family":"Iino","sequence":"additional","affiliation":[{"name":"Department of Gastroenterology Chiba Prefecture Saiseikai Narashino Hospital  Chiba Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jo","family":"Kurosawa","sequence":"additional","affiliation":[{"name":"Department of Gastroenterology Chiba Prefecture Saiseikai Narashino Hospital  Chiba Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ken","family":"Uchida","sequence":"additional","affiliation":[{"name":"Department of Gastroenterology Chiba Prefecture Saiseikai Narashino Hospital  Chiba Japan"},{"name":"Department of Gastroenterology Chiba University Hospital  Chiba Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Daiki","family":"Takahashi","sequence":"additional","affiliation":[{"name":"Department of Gastroenterology Chiba Prefecture Saiseikai Narashino Hospital  Chiba Japan"},{"name":"Department of Gastroenterology Chiba University Hospital  Chiba Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yuya","family":"Yokoyama","sequence":"additional","affiliation":[{"name":"Department of Gastroenterology Chiba Prefecture Saiseikai Narashino Hospital  Chiba Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hiroshi","family":"Ohyama","sequence":"additional","affiliation":[{"name":"Department of Gastroenterology Chiba University Hospital  Chiba Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Futoshi","family":"Hirai","sequence":"additional","affiliation":[{"name":"Department of Gastroenterology Chiba Prefecture Saiseikai Narashino Hospital  Chiba Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Michikazu","family":"Abe","sequence":"additional","affiliation":[{"name":"Department of Gastroenterology Chiba Prefecture Saiseikai Narashino Hospital  Chiba Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jun","family":"Kato","sequence":"additional","affiliation":[{"name":"Department of Gastroenterology Chiba University Hospital  Chiba Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2026,9,11]]},"reference":[{"key":"e_1_2_10_2_1","doi-asserted-by":"crossref","first-page":"380","DOI":"10.1016\/j.gie.2022.04.060","article-title":"Delayed Duodenal Perforation by Placement of Transmural Double\u2010Pigtail Stents After Successful Drainage of Walled\u2010Off Pancreatic Necrosis","volume":"96","author":"Iwano K.","year":"2022","journal-title":"Gastrointestinal Endoscopy"},{"key":"e_1_2_10_3_1","doi-asserted-by":"crossref","first-page":"150","DOI":"10.11641\/pde.86.1_150","article-title":"Duodenal Penetration by a Plastic Stents (PSs) During EUS\u2010Guided Drainage for Walled\u2010Off Necrosis (WON)","volume":"86","author":"Ajihara T.","year":"2015","journal-title":"Progress of Digestive Endoscopy"},{"key":"e_1_2_10_4_1","doi-asserted-by":"crossref","first-page":"158","DOI":"10.1016\/j.vgie.2023.11.002","article-title":"Diagnosis and Treatment of a Biliary Fistula to Walled\u2010Off Pancreatic Necrosis","volume":"9","author":"Park E.","year":"2023","journal-title":"Video GIE"},{"key":"e_1_2_10_5_1","doi-asserted-by":"crossref","first-page":"510","DOI":"10.1097\/00000658-195404000-00018","article-title":"Choledochoduodenal Fistula: Its Surgical Management","volume":"139","author":"Walker G.","year":"1954","journal-title":"Annals of Surgery"},{"key":"e_1_2_10_6_1","doi-asserted-by":"crossref","first-page":"1057","DOI":"10.1002\/jhbp.1146","article-title":"JPN Clinical Practice Guidelines 2021 With Easy\u2010to\u2010Understand Explanations for the Management of Acute Pancreatitis","volume":"29","author":"Takada T.","year":"2022","journal-title":"Journal of Hepato\u2010Biliary\u2010Pancreatic Sciences"},{"key":"e_1_2_10_7_1","doi-asserted-by":"crossref","first-page":"383","DOI":"10.1097\/MCG.0000000000000016","article-title":"Implantation of Covered Self\u2010Expandable Metal Stent in the Common Bile Duct for the Treatment of Choledochoduodenal Fistula","volume":"48","author":"Zhao S.","year":"2014","journal-title":"Journal of Clinical Gastroenterology"}],"container-title":["DEN 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