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Endoscopic ultrasound-guided hepaticogastrostomy (EUS-HGS). (a) Bile duct is punctured with a 19-G needle. (b) Guidewire is inserted into the bile duct. (c) Metallic stent is placed.
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After the absence of blood vessels crossing the puncture route was confirmed, the bile duct was punctured with a 19-G needle (EZ shot 3; Olympus) (Figure 1(a)). Subsequently, the puncture site was dilated with a 3.6-Fr double-lumen catheter (Uneven Double Lumen Catheter; PIOLAX, Tokyo, Japan), and another 0.035-inch wire (Revowave; PIOLAX, Tokyo, Japan) was introduced into the jejunum (Figure 1(b)). An 8 mm covered MS (Niti-S; TaeWoong Medical Inc., Seoul, Korea) was placed (Figure 1(c)).
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