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

Figure 2 Endoscopic ultrasound-guided hepaticogastrostomy for benign distal biliary stricture in a patient with history of roux-en-Y gastric bypass surgery. A: Endoscopic ultrasound-guided puncture of a dilated B3 radical with a 19-gauge needle; B: Fluoroscopic image showing a dilated bile duct with distal biliary stricture; C: Fluoroscopic image showing placement of a fully covered hepaticogastrostomy metal stent; D: Antegrade balloon dilation of the distal bile duct stricture using a wire-guided balloon; E: Successful placement of four 7 Fr × 18 cm double pigtail biliary stents with the distal end past the ampulla in the small bowel and the proximal end in the stomach; F: Occlusion cholangiogram following removal of plastic hepaticogastrostomy stents showing resolution of distal bile duct stricture with free flow of contrast into the small bowel.