A novel technique of B2–B3 single-puncture bridging through liver parenchyma enabling endoscopic ultrasound-guided hepaticogastrostomy for rescue drainage

Malignant hilar biliary strictures often result in separation of intrahepatic bile ducts, necessitating placement of multiple stents to achieve adequate drainage [1]. Endoscopic ultrasound-guided hepaticogastrostomy (EUS-HGS) has emerged as a valuable salvage option when transpapillary access is limited [2] [3]. Although EUS-guided bridging techniques have been reported, intrahepatic bridging through the liver parenchyma has not yet been described [4].