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Procedural steps of EUS-GBD. The cystic duct (arrowhead) is blocked by an indwelling covered SEMS placed for distal biliary obstruction (a). Both the cystic duct (arrowhead) and posterior intrahepatic duct (arrow) are dilated (b). The gallbladder is punctured with a 19-gauge EUS-FNA needle (c). A covered SEMS is introduced, with one indwelling pig-tail plastic stent placed though the SEMS, resulting in successful drainage of the infectious green bile (d).
