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Endoscopic ultrasound‐guided hepaticogastrostomy as a salvage procedure for management of distal bile duct stricture, migrated self‐expandable metal stent, and hepatolithiasis in a patient with surgically altered gastrointestinal anatomy

A 68-year-old woman with history of Roux-en-Y gastric bypass surgery and cholecystectomy presented with cholangitis. Six months prior to presentation, she was admitted to an outside hospital with gallstone pancreatitis and managed with percutaneous transhepatic biliary drainage. Her clinical course was complicated by proximal migration of a self-expandable metal stent (SEMS) placed for a distal bile duct stricture and recurrent cholangitis due to residual intrahepatic and extrahepatic stone disease. After discussion with the patient regarding treatment options, she underwent an endoscopic ultrasound-guided hepaticogastrotomy (EUS-HG) for biliary drainage (1).