Endoscopic ultrasound-guided choledochoduodenostomy in patients with failed endoscopic retrograde cholangiopancreatography

Figure 1 Convex echoendoscope clearly depicts the extrahepatic bile duct (green) (patient 3). GB: Gallbladder; CBD: Common bile duct; PV: Portal vein.

Figure 2 After EUS-guided puncture, contrast medium is injected into the bile duct for cholangiogram, a 0. 035-inch guidewire was inserted into the outer sheath (patient 3).

Figure 3 A: Choledochoduodenostomy was accomplished with a 7-Fr plastic stent in the apex of the duodenal bulb (patient 3); B: The stent was visible in the duodenal bulb (patient 3).

Figure 4 Choledochoduodenostomy was accomplished using a 5-Fr naso-biliary tube (patient 2).

Figure 5 A: Macroscopic view of completed choledochoduodenostomy (patient 2); B: Surgical specimens showing the completed choledochoduodenostomy with mild inflammatory cell infiltrate adjacent to the sinus tract in the duodenal and bile duct walls (HE, × 20, patient 2); C: Magnification of bile duct site (HE, × 100, patient 2); D: Magnification of bile duct site (HE, × 100, patient 2). BD: Bile duct.