Electrohydraulic lithotripsy through a fistula of EUS-guided hepaticogastrostomy: a new approach for right intrahepatic stones

A 50-year-old man with a history of hepaticojejunostomy and Roux-en-Y reconstruction for congenital biliary dilatation presented with repeated episodes of cholangitis due to bilateral intrahepatic stones (Fig. 1). An approach to hepaticojejunostomy anastomosis by double-balloon endoscope failed because of intestinal adhesions and a long afferent loop, and percutaneous transhepatic biliary access was impossible because of poor US visualization of...