Endoscopic ultrasound-guided biliary drainage-current status and future perspectives

Figure 1 Left hepatic duct puncture and contrast injection. A: Cholangiogram; B: endoscopic ultrasound image.

Figure 2 Hydrophilic guidewire insertion. A: In left hepatic duct; B: To the distal common bile duct.

Figure 3 Tract dilatation. A: Biliary dilation catheter; B: 4 mm balloon dilatator.

Figure 4 Stent placement-self-expandable metal stent. A: Cholangiogram; B: Endoscopic image.

Figure 5 Endoscopic ultrasound-guided antegrade stenting. A: Left hepatic duct puncture with 19G needle; B: Guide-wire insertion; C: Tract dilatation and advancing the biliary catheter tip transpapillary in the duodenum; D: Self-expandable metal stent placement.

Figure 6 Endoscopic ultrasound-guided choledochoduodenostomy. A: Puncture of the common bile duct with 19G needle and contrast injection; B: Hydrophilic guidewire inserted through the needle into bile ducts; C: Fluoroscopic image of self-expandable metal stent (SEMS); D: Endoscopic image of SEMS.

Figure 7 Endoscopic ultrasound-guided rendezvous technique. A: Puncture the left hepatic duct with 19G needle; B: Guide-wire insertion in bile ducts; C: Guide-wire insertion transpapillary in the duodenum; D: Grasping the guide-wire with a rath tooth forceps; E: Endoscopic image of two self-expandable metal stent (SEMS); F: Fluoroscopic image of two SEMS.

Figure 8 Current place of endoscopic ultrasound-guided biliary drainage in endoscopic biliary drainage therapy. EUS-BD: Endoscopic ultrasound-guided biliary drainage; EUS-RV: EUS-guided rendezvous technique; EUS-AS: EUS-guided antegrade stenting; EUS-CDS: EUS-guided choledochoduodenostomy/choledochoantrostomy; EUS-HGS: EUS-guided hepaticogastrostomy.