Endoscopic ultrasound-guided biliary drainage with placement of a fully covered metal stent for malignant biliary obstruction

Figure 1 Endoscopic ultrasound-guided hepaticogastrostomy. A: In the intrahepatic approach, the linear array echoendoscope was placed in the lesser curvature of the stomach for viewing the left intrahepatic system. A 0.035-inch guidewire was introduced through the endoscopic ultrasonography-needle and advanced in an antegrade manner; B and C: A fully covered metal stent was placed under echoendoscopic and fluoroscopic view.

Figure 2 Endoscopic ultrasound-guided choledochoduodenostomy. A: The extrahepatic approach was carried out using an echoendoscope in the duodenal bulb, permitting imaging of the choledochus. Bile duct puncture was carried out with a 19-gauge needle; B: A 0.035-inch guidewire was introduced through the endoscopic ultrasonography-needle and advanced in a retrograde fashion; C and D: A fully covered metal stent was placed under echoendoscopic and fluoroscopic view.