Figure 1.

EUS-guided choledochoduodenostomy in a 53-year-old male for recurrent cholangitis status postorthotopic liver transplantation with Roux-en-Y hepaticojejunostomy and hepaticojejunostomy stricture. (a and b) Linear echoendoscope was advanced to D1 and the dilated bile duct was identified. (c) Under EUS guidance, a 19-gauge needle was advanced into the bile duct, and a cholangiogram was performed by injecting contrast. (d) A 0.025-inch guidewire was advanced through the needle into the intrahepatic ducts. A 10 mm × 40 mm fully covered self-expanding metal stent was advanced over the wire and deployed successfully creating the choledochoduodenostomy. (e) A 7 Fr × 5 cm double-pig tail was deployed through the fully covered self-expanding metal stent to avoid stent migration. (f) On a different session, the two stents were removed, and pediatric gastroscope was advanced through the created choledochoduodenostomy. Cholangiogram revealed diffuse intrahepatic strictures with beaded appearance