Endoscopic Ultrasound-guided cholangiopancreatography and rendezvous techniques

Ultrasonographic view with colour flow Doppler of a dilated left hepatic before EUS-guided puncture.

Injection of contrast through the EUS needle, demonstrating successful opacification of the intrahepatic duct (fluoroscopic view).

A guidewire is advanced through the EUS needle and into the biliary tree across the stricture.

Dilation of the tract between the stomach and the left intrahepatic duct in antegrade fashion.

Metal stent deployment across the distal stricture.

Extrahepatic puncture of the common bile duct.

Advancement of the guidewire from the bile duct in an antegrade fashion during an extrahepatic approach.

Pancreatogram demonstrating dilated pancreatic duct above a distal stricture.

Advancement of a guidewire in a antegrade fashion across the stricture.

Balloon dilation of the pancreatogastric fistula.

Placement of a 7F stent through the pancreatogastric fistula.