Fig. 1. Technique of endoscopic ultrasound (EUS)-guided choledochoduodenostomy: (A) With the scope in the duodenal bulb, the best position is the long one with probe and needle toward the liver hilum. (B) Common bile duct (CBD) puncture using a 19 G needle with subsequent contrast opacification. (C) Guidewire manipulation under EUS guidance. (D) Fistulous tract dilatation using a 6-Fr cystotome. (E) Stent deployment, with special concern to deploy the distal end inside the scope’s working channel. (F) Directing distal end of the stent towards the anal side by manipulating the delivery system.
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