Recent advances in endoscopic ultrasonography-guided biliary interventions

Figure 1 Endoscopic ultrasonography-guided choledochoduodenostomy. A: Endoscopic ultrasonography showing that extrahepatic bile duct was punctured by the needle; B: Guidewire was advanced through the needle into the right liver lobe; C: A self-expandable metallic stent (SEMS) was placed between the bile duct and the duodenum; D: Endoscopic view showing that the distal end of a SEMS was located at the duodenum.

Figure 2 Endoscopic ultrasonography-guided hepaticogastrostomy. A: Left intrahepatic bile duct was punctured; B: Cholangiography showing distal malignant stricture (arrow); C: Following antegrade self-expandable metallic stent placement, a plastic stent was deployed between the intrahepatic bile duct and stomach; D: Endoscopic view showing that the distal end of the plastic stent was located at the stomach.

Figure 3 Endoscopic ultrasonography-guided gallbladder drainage. A: Endoscopic ultrasonography showing that the gallbladder was punctured by the needle; B: Guidewire was advanced through the needle into the gallbladder; C: A self-expandable metallic stent (SEMS) was placed between the gallbladder and the duodenum; D: Endoscopic view showing that distal end of a SEMS was located at the stomach.

Figure 4 Endoscopic ultrasonography-guided rendezvous procedure. A: Endoscopic ultrasonography showing that extrahepatic bile duct was punctured by the needle; B: Radiography showing the guidewire was passed through the needle into the duodenum across the papilla antegradely. The endoscope was in the short position; C: Following echoendoscope withdrawal, the duodenoscopic view showed that a guidewire passing through the papilla was grasped by the snare; D: After the guidewire was pulled out through the accessary channel of the duodenoscope, a catheter was inserted into the bile duct over the existing guidewire; E: Transhepatic approach. Abdominal radiography shows that a guidewire was placed through the papilla into the duodenum.

Figure 5 Endoscopic ultrasonography-guided antegrade treatment. A: Left intrahepatic bile duct was punctured; B: Guidewire was advanced through the needle across the stricture (arrow); C: A self-expandable metallic stent was placed antegradely across the stricture.