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Changing the needle direction after biliary puncture in the PEHBD/D1 route. The proximal extrahepatic bile duct was punctured from the duodenal bulb with an unfavorable needle direction (A). Changing the needle direction to the caudal side by pushing the scope to the cranial side and using the up-angle of the scope (B). PEHBD/D1, proximal extrahepatic bile duct/duodenal bulb.
