Fig. 1. Treatment strategy. The arrowheads show the stagnation of contrast medium, double plastic stents (PSs), and stricture resolution. EUS-BD, endoscopic ultrasound-biliary drainage; DPPS, double pigtail plastic stent; POCS, peroral cholangioscope; EHL, electrohydraulic lithotripsy; CSEMS, covered self-expandable metallic stent; FCSEMS, fully CSEMS.

Fig. 2. Flowchart of patient treatment. EUS-BD, endoscopic ultrasound-biliary drainage; HJSS, hepaticojejunostomy stricture.

Fig. 3. Peroral cholangioscopic examination of hepaticojejunal stricture. (A) Typical benign stricture (arrow) with a penetrating guidewire. Scar tissue was observed around strictures. (B) Mini-biopsy of the hepaticojejunal stricture forceps (SpyBite and SpyBite MAX; Boston Scientific).

Fig. 4. Intrahepatic bile duct stones (circle) and electrohydraulic lithotripsy probe (EHL AutolithTOUCH; Northgate Technologies).

Graphical abstract