Novagold

Prior to EUS-HGS, antibiotics were administered intravenously. EUS-HGS was performed by using an oblique-viewing linear echoendoscope (GF-UCT260; Olympus, Tokyo, Japan). Carbon dioxide insufflation was used during the procedure unless contraindicated. The intrahepatic bile duct from the stomach was identified and punctured using a FNA needle (EZ Shot 3 Plus; Olympus, Tokyo, Japan) under EUS guidance. Sodium meglumine amidotrizoate contrast medium was injected, and cholangiography was performed. A 0.018-inch guidewire (NovaGold; Boston Scientific, Tokyo, Japan or Fielder 18; ASAHI INTECC, Aichi, Japan) was inserted through the needle into the intrahepatic bile duct. Both the stomach and bile duct walls were dilated using a mechanical dilator (ES Dilator; Zeon Medical, Tokyo, Japan). After tract dilation, a dedicated plastic stent was placed from the intrahepatic bile duct to the stomach (Fig. 1). In cases where the mechanical dilator could not be inserted into the biliary tract, the catheter for ERCP or a 4mm balloon dilator (REN; Kaneka, Osaka, Japan) was first inserted into the biliary tract, and the guidewire was exchanged for a 0.025-inch guidewire (VisiGlide2; Olympus, Tokyo, Japan). Similarly, in cases where the stent delivery system could not be inserted into the biliary tract, the guidewire was exchanged for a 0.025-inch guidewire.