Fig. 2. Images during endoscopic ultrasound-guided biliary drainage. (A) The extrahepatic bile duct was punctured using a 19-gauge needle. There was a small amount of ascites (arrow) between the duodenal wall and extrahepatic bile duct. (B) Contrast enhancement of the bile duct. (C) After dilation with a 4-mm balloon, the common bile duct collapsed due to bile juice leakage (arrow). (D) The duodenal bulb was closed using clips. (E) The intrahepatic bile duct (B2) was punctured using a 19-gauge needle, and a 0.025-inch guidewire was inserted. Subsequently, a small amount of contrast medium was injected to confirm the biliary tree. (F) A 10 mm × 6 cm fully covered self-expandable metallic stent (FCSEMS, X-Suit NIR; Olympus) was placed as an antegrade stent to cover the puncture site, while a 6 mm × 12 cm FCSEMS (Hanarostent; Boston Scientific) was placed via the stomach.
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