Abstract
A 91yo man with history of Roux-en-Y reconstruction was admitted due to acute cholangitis. Cholangio-MRI: choledocholitiasis with intra and extrahepatic bile duct dilatation. A linear echoendoscope was used to perform an endoscopic biliary drainage. Firstly, EUS-guided biliary accesses by transgastric puncture of left intrahepatic biliary radical, confirmed by serum-instillation and bile-aspiration. Secondly, advancement of a guidewire anterogradely until reach enteral loop, through the papilla y by fluoroscopy-guidance. Finally, a transgastric-hepatic ostomy using a 6-Fr cystotome, and antegrade papilloplasty using a CRE balloon allowed a EUS-guided antegrade stenting (Biliary fully-covered metal stent, 60 x 10mm) without incidences. Publication Date: 14 April 2022 (online) © 2022. European Society of Gastrointestinal Endoscopy. All rights reserved. Georg Thieme Verlag KG Rüdigerstraße 14, 70469 Stuttgart, Germany