Endoscopic ultrasonography-guided transhepatic antegrade stone removal in patients with surgically altered anatomy: case series and technical review (with videos)

Recently, endoscopic ultrasonography (EUS)‐guided transhepatic antegrade interventions have been introduced in patients with a surgically altered anatomy. Herein, we focused on and reviewed EUS‐guided transhepatic antegrade stone removal (EUS‐TASR) in patients with a surgically altered anatomy and native papilla. The basic technique of EUS‐TASR involves the following steps: (1) EUS‐guided needle puncture; (2) guidewire placement; (3) tract dilation; (4) balloon sphincteroplasty; (5) stone removal; and (6) stent placement if needed. Based on reports in the literature including our cases, the complete stone extraction rate is 71.4% (10/14) including five of our cases (60% success rate) at one session without serious complications. In conclusion, EUS‐TASR appears to be feasible and useful in selected patients although its application may be limited depending on anatomical factors and current devices used.