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. 2017 Dec 1;96(48):e8991. doi: 10.1097/MD.0000000000008991

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Copyright © 2017 the Author(s). Published by Wolters Kluwer Health, Inc.

This is an open access article distributed under the terms of the Creative Commons Attribution-Non Commercial-No Derivatives License 4.0 (CCBY-NC-ND), where it is permissible to download and share the work provided it is properly cited. The work cannot be changed in any way or used commercially without permission from the journal. http://creativecommons.org/licenses/by-nc-nd/4.0

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Push-pull technique-2 in a patient with inoperable Bismuth type IIIa malignant hilar cholangiocarcinoma. (A) Left percutaneous transhepatic biliary drainage tube and a stent-in-stent in the right anterior and posterior intrahepatic ducts. (B) Percutaneous dilator could not be passed through the tight hilar stricture; only the antegrade guidewire (AGW) could be passed. (C) Retrograde advancement of a balloon dilating catheter through the stricture was performed by simultaneously pulling the AGW and pushing the endoscope toward the percutaneous side. (D) Successful balloon dilation of the stricture. (E and F) Completed triple hilar stenting.