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A 54-year-oldwoman underwent curative duodenectomywithduodenojejunal anastomosis for adenocarcinoma. The day after the procedure she developed jaundice. The computed tomography (CT) scan showed a staple line on the lower part of the common bile duct (CBD) with biliary tree dilatation (●" Fig.1) and a normal pancreatic duct. Under endoscopic ultrasound (EUS) control a transbulbar cholangiography was performed on the lower part of the CDB, confirming biliary dilatation without any leakage of contrast medium into the duodenum (●" Video1). A fistulotomy (6Fr) was then performed (●" Video2). Although different guidewires and catheters were used, selective cannulation of the cystic stump was achieved without reaching the intrahepatic ducts because of the anatomically low cystic duct insertion (●" Fig.2). A transhepatic cholangiography was performed. Passage of the guidewire into the duodenum was easily done through the bilioduodenal access previously created by EUS fistulotomy (●" Fig.3). A fully covered self-expanding metal stent (FCSEMS) and a plastic stent were delivered to maintain biliary flow (●" Fig.4). Follow-up was uneventful with normalization of liver function test results, and endoscopic retrograde cholangiopancreatography (ERCP) was scheduled for stent replacement. Iatrogenic injury of the biliary tree following surgery on organs of the epigastrium other than the biliary tract is well known [1]. Successful EUS-guided choledochoFig.1 a,b Staple line on the common bile duct (arrow) with dilation of the biliary tree and a normal pancreatic duct in a 54-year-old patient after curative duodenectomy with duodenojejunal anastomosis for adenocarcinoma. Fig.2 Looping of the guidewire in the cystic stump.

Salvage endoscopic ultrasound–radiologic rendezvous to re-establish biliary flow following duodenectomy with ablation of papilla