Endoscopic ultrasound guided rendez-vous technique performed for stent implantation

When Endoscopic retrograde cholangiopancreatography (ERCP) fails in patients with obstructive jaundice, EUS-guided rendezvous technique (EUS-RV) becomes an alternative treatment. For the EUS-RV, we can puncture the intrahepatic bile duct (IHBD) and the extrahepatic bile duct (EHBD). Puncturing the EHBD needs through duodenum, the puncture site can be divided into via the proximal duodenum (D1) and via the second portion of the duodenum (D2). Puncturing the IHBD will difficult to perform at the patients whose IHBD is not dilated. For these patients, puncturing EHBD becomes an unavoidable choice. Generally, the closer the puncture point is to the duodenal papilla, the more difficult it is to implant the stent. Therefore, we innovatively adopted the method that concomitantly withdrawing the guidewire during stent deployment.