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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-directed transgastric endoscopic retrograde cholangiography for choledocholithiasis in a patient with history of roux-en-Y gastric bypass surgery. A: Endoscopic ultrasound-guided puncture of excluded stomach using a 19-gauge needle; B: Endoscopic ultrasound showing deployment of proximal flange of lumen-apposing self-expanding metal stent (LAMS) in the excluded stomach; C: Endoscopic image showing distal flange of LAMS in the gastric pouch; D: Fluoroscopic image of endoscopic retrograde cholangiopancreatography through LAMS showing multiple stones in the common bile duct; E: Gastrogastric fistula seen following LAMS removal; F: Successful closure of gastrogastric fistula using argon plasma coagulation and clips.