EUS-guided cholangiography

(A) EUS-guided cholangiography for antegrade access to the bile duct following unsuccessful retrograde access with ERCP. Two large filling defects consistent with choledocholithiasis are seen on the cholangiogram.
(B) A guidewire is passed through the fine-needle aspiration needle into the bile duct and across the major duodenal papilla into the second portion of the duodenum in preparation for a "rendezvous" procedure.
(C) The guidewire is then snared and withdrawn through a side-viewing duodenoscope, allowing access to the bile duct for completion of the "rendezvous" procedure. Stone extraction is then performed using conventional ERCP techniques.