Single-session endoscopic ultrasound-guided tissue acquisition followed by choledochoduodenostomy in a patient with Roux-en-Y reconstruction

Endoscopic ultrasound-guided tissue acquisition (EUS-TA) through the afferent limb of a Roux-en-Y reconstruction is possible but challenging [1] [2]. In reconstructed patients with subsequent distal malignant biliary obstruction, EUS-TA with endoscopic ultrasound-guided choledochoduodenostomy (EUS-CDS) potentially achieves both pathological diagnosis and biliary drainage in a single session.