Endoscopic Ultrasound-Guided Biliary Drainage Using a Fully Covered Metallic Stent after Failed Endoscopic Retrograde Cholangiopancreatography

Figure 2

(a) Echoendoscope was advanced into the duodenal bulb. After checking local vasculature with color Doppler, the EUS puncture needle was then advanced into the intrahepatic duct. (b) Cholangiography was performed, which usually delineates the dilated biliary tree down to the point of obstruction. (c) The cystotome was used to create a fistula between the stomach and the left hepatic duct. (d) The puncture site after dilation. (e) The guidewire was observed under the EUS. (f)–(h) The fully covered SEMS was inserted and deployed transmurally. (i) To avoid bile leakage into the peritoneum, a 7 Fr nasobiliary was placed through the metallic stent.

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