Electrohydraulic lithotripsy through a fistula of EUS-guided hepaticogastrostomy: a new approach for right intrahepatic stones Tatsuya Sato, MD, Yousuke.

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Electrohydraulic lithotripsy through a fistula of EUS-guided hepaticogastrostomy: a new approach for right intrahepatic stones Tatsuya Sato, MD, Yousuke Nakai, MD, PhD, Hirofumi Kogure, MD, PhD, Hiroyuki Isayama, MD, PhD, Kazuhiko Koike, MD, PhD VideoGIE DOI: 10.1016/j.vgie.2019.04.017 Copyright © 2019 American Society for Gastrointestinal Endoscopy Terms and Conditions

Figure 1 Magnetic resonance cholangiopancreatographic view delineating multiple large stones in the bilateral intrahepatic bile ducts (arrows) in a patient with a history of hepaticojejunostomy and Roux-en-Y reconstruction. VideoGIE DOI: (10.1016/j.vgie.2019.04.017) Copyright © 2019 American Society for Gastrointestinal Endoscopy Terms and Conditions

Figure 2 Schema of Roux-en-Y hepaticojejunostomy and EUS-guided approach to the left intrahepatic bile duct. VideoGIE DOI: (10.1016/j.vgie.2019.04.017) Copyright © 2019 American Society for Gastrointestinal Endoscopy Terms and Conditions

Figure 3 EUS-guided hepaticogastrostomy by placement of a 7F-wide, 20-cm-long, double-pigtail plastic stent between the stomach and jejunum. VideoGIE DOI: (10.1016/j.vgie.2019.04.017) Copyright © 2019 American Society for Gastrointestinal Endoscopy Terms and Conditions

Figure 4 Balloon dilation of hepaticojejunostomy anastomosis. VideoGIE DOI: (10.1016/j.vgie.2019.04.017) Copyright © 2019 American Society for Gastrointestinal Endoscopy Terms and Conditions

Figure 5 Fluoroscopic image of antegrade removal of left intrahepatic bile duct stones by use of a retrieval balloon. VideoGIE DOI: (10.1016/j.vgie.2019.04.017) Copyright © 2019 American Society for Gastrointestinal Endoscopy Terms and Conditions

Figure 6 Fluoroscopic image of residual right intrahepatic bile duct stones (arrows). VideoGIE DOI: (10.1016/j.vgie.2019.04.017) Copyright © 2019 American Society for Gastrointestinal Endoscopy Terms and Conditions

Figure 7 A, Fluoroscopic image of electrohydraulic lithotripsy through a cholangioscope inserted through an EUS-guided hepaticogastrostomy fistula. B, Cholangioscopic image of electrohydraulic lithotripsy. VideoGIE DOI: (10.1016/j.vgie.2019.04.017) Copyright © 2019 American Society for Gastrointestinal Endoscopy Terms and Conditions

Figure 8 Fluoroscopic image suggesting complete stone clearance. VideoGIE DOI: (10.1016/j.vgie.2019.04.017) Copyright © 2019 American Society for Gastrointestinal Endoscopy Terms and Conditions