Endoscopic ultrasound-guided transhepatic antegrade stone removal for choledocholithiasis after pancreaticoduodenectomy: A case report and review of literature

Figure 2 Procedural steps of successful endoscopic ultrasound-guided transhepatic antegrade stone removal. A: Puncture of a bile duct branch in segment S2 of the liver using a fine-needle aspiration needle; B: Cholangiography confirming mildly dilated intrahepatic bile ducts and a hyperechoic nodule (stone) within the common hepatic duct (yellow arrowheads); C: A needle knife is used to incise the gastric wall and the liver parenchyma to establish a hepatoenteric tract; D: The guidewire is advanced across the biliary-enteric anastomosis into the jejunum; E: Dilation of the created hepatoenteric tract; F: Sequential balloon dilation of the biliary-enteric anastomosis; G: The stone within the common hepatic duct (orange arrowheads) is dislodged and pushed into the jejunum using a retrieval balloon catheter (yellow arrowheads); H and I: Placement of a nasobiliary drainage catheter across the biliary-enteric anastomosis.