EUS-guided choledochoduodenostomy with use of a lumen-apposing metal stent: the freehand technique

Endoscopic retrograde cholangiography (ERC) with placement of a biliary stent is the primary mechanism for biliary drainage in patients with malignant biliary obstruction. This technique can be impossible in certain circumstances. In such cases, EUS-guided choledochoduodenostomy (CDS) with the use of a lumen-apposing metal stent (LAMS) has been described as an alternative. It is unclear whether pre-existing guidewire access is needed before...