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

Figure 3 Endoscopic ultrasound-guided gallbladder drainage for distal malignant biliary obstruction secondary to duodenal adenocarcinoma using an electrocautery-enhanced lumen apposing metal stent. A: Duodenal adenocarcinoma involving the duodenal sweep causing luminal narrowing; B: Adenocarcinoma (arrow heads) arising in a background of adenoma (arrow) with focal high-grade dysplasia (H&E stain); C: Endoscopic ultrasound image displaying distended gallbladder; D: Cholecystoscopy [post lumen-apposing self-expanding metal stent (LAMS) placement] with contrast injection via cystic duct opening opacifying the biliary tree showing a patent cystic duct; E: Post-procedural computed tomography scan displaying double pigtail stent and LAMS in place between gastric antrum and gallbladder.