Fig. 3. Endoscopic ultrasound (EUS)-guided hepaticoduodenostomy (HDS) using a 7-Fr double-pigtail plastic stent (DPPS) for obstruction of the right intrahepatic duct (IHD). (A) After failed cannulation to the right IHD, EUS-HDS was performed in patients with right intrahepatic obstruction. On EUS, a dilated right IHD was observed on the expected needle track. (B, C) The right posterior IHD was punctured by a 19-gauge standard needle. (D) The guidewire was delivered up to only right posterior IHD. (E) The fistula tract was dilated using a 4-mm balloon catheter. (F) A 7-Fr DPPS was placed through hepaticoduodenostomy. A fluoroscopic image showing the stent placed between the duodenum and the right posterior IHD.
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