Conversion of percutaneous transhepatic biliary drainage to endoscopic ultrasonography-guided hepaticogastrostomy under balloon-targeted selective needle puncture.

Endoscopic ultrasonography (EUS)-guided hepaticogastrostomy is a rescue technique for internal drainage when percutaneous antegrade biliary stenting (PABS) fails after percutaneous transhepatic biliary drainage (PTBD). However, this may be difficult under bile duct decompression despite contrast injection through the PTBD catheter because the sonographic ring-down artifact caused by micro-air bubbles in the contrast may hinder the EUS delineation of the intrahepatic bile duct.