Endoscopic ultrasound-guided biliary drainage: Are we there yet?

Figure 1 Endoscopic ultrasound-guided choledochoduodenostomy for distal malignant biliary obstruction using an electrocautery-enhanced lumen apposing metal stent. A: Fluoroscopic image showing a dilated bile duct with distal biliary stricture secondary to pancreas head mass; B: Endoscopic image following lumen-apposing self-expanding metal stent (LAMS) deployment in the common bile duct; C: Balloon dilation of LAMS using a wire-guided balloon; D: Endoscopic image with double pigtail stent through the LAMS in the duodenal bulb; E: Computed tomography coronal image showing choledochoduodenostomy with a double pigtail stent through the LAMS. The proximal end of the double pigtail plastic stent is in the left intrahepatic duct.