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EUS-guided hapaticogastrostomy using an ultra-tapered mechanical dilator. A 19G fine needle aspiration needle was advanced into the non-marked dilated intrahepatic bile duct under EUS guidance (left upper). After a 0.025 inch Guidewire was placed in the bile duct, the ultra-tapered mechanical dilator was inserted sufficiently into the bile duct (arrow, radiopaque marker) (right upper). A dedicated plastic stent was placed (lower)
