Simplified fistula dilation technique and modified stent deployment maneuver for EUS-guided hepaticogastrostomy

Figure 2 Endoscopic ultrasonography-guided hepaticogastrostomy using a 4 mm balloon dilation catheter with stainless steel stylet and an 8 mm fully covered metal stent with dual flaps. A: A 0.035-inch guidewire was introduced into the bile duct and fistula dilation was performed in two sites (liver parenchyma and fistula tract) using a 4 mm biliary balloon dilatation catheter; B: The dual-flap fully covered metal stent was deployed within the bile duct (half of metal stent) under echoendoscopic and fluoroscopic guidance, and echoendoscope channel (remained portion of metal stent) under fluoroscopic guidance, and then placed in hepaticogastrostomy site.