Feasibility of therapeutic endoscopic ultrasound in the bridge-to-surgery scenario: The example of pancreatic adenocarcinoma

Figure 1 Endoscopic ultrasound-guided choledochoduodenostomy. A: Endosonographic identification of a window for endoscopic ultrasound-guided choledochoduodenostomy in a potentially resectable patient. The common bile duct (CBD) is evaluated from liver hilum to the neoplasia. A spot without intervening vessels is chosen as close as possible to the neoplasia; the caliber of the CBD is evaluated in the direction of the operative channel of the endoscope (yellow dotted line); B: The tip (arrow) of the electrocautery-enhanced lumen apposing metal stent is visibly in touch with the duodenal wall adjacent to a dilated CBD; C: The electrocautery-enhanced lumen apposing metal stent has passed through duodenal and biliary walls, and the distal flange (arrow) has been released inside the CBD; D: The proximal flange has been released inside the bulb with successful drainage of bile flow at the end of the procedure.