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. 2021 Aug 16;13(8):302–318. doi: 10.4253/wjge.v13.i8.302

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©The Author(s) 2021. Published by Baishideng Publishing Group Inc. All rights reserved.

This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/Licenses/by-nc/4.0/

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Endoscopic ultrasound-guided hepaticogastrostomy for benign distal biliary stricture in a patient with history of roux-en-Y gastric bypass surgery. A: Endoscopic ultrasound-guided puncture of a dilated B3 radical with a 19-gauge needle; B: Fluoroscopic image showing a dilated bile duct with distal biliary stricture; C: Fluoroscopic image showing placement of a fully covered hepaticogastrostomy metal stent; D: Antegrade balloon dilation of the distal bile duct stricture using a wire-guided balloon; E: Successful placement of four 7 Fr × 18 cm double pigtail biliary stents with the distal end past the ampulla in the small bowel and the proximal end in the stomach; F: Occlusion cholangiogram following removal of plastic hepaticogastrostomy stents showing resolution of distal bile duct stricture with free flow of contrast into the small bowel.