Varayu PrachayakulPitulak AswakulMahidol UniversitySamitivej Hospital (Sukhumvit)2018-11-232018-11-232015-09-14World Journal of Gastroenterology. Vol.21, No.34 (2015), 10045-1004822192840100793272-s2.0-84941281995https://repository.li.mahidol.ac.th/handle/20.500.14594/36328© The Author(s) 2015. Published by Baishideng Publishing Group Inc. All rights reserved. © 2015 Baishideng Publishing Group Inc. All rights reserved. Endoscopic ultrasound (EUS)-guided biliary drainage is accepted as a less invasive, alternative treatment for patients in whom endoscopic retrograde cholangiopancreatography has failed. Most patients with malignant hilar obstruction undergo EUSguided hepaticogastrostomy. The authors present the case of a 77-year-old man with advanced hilar cholangiocarcinoma who had undergone a rouxen- Y hepaticojejunostomy several months prior. He developed progressive jaundice and a low-grade fever that persisted for one week. The enteroscopic-assisted endoscopic retrograde cholangiopancreatography failed, thus the patient was scheduled for EUS-guided biliary drainage. In order to obtain adequate drainage, both intrahepatic systems were drained. This report describes the technique used for bilateral drainage via a transgastric approach. Currently, only a few different techniques for EUS-guided right system drainage have been reported in the literature. This case demonstrates that bilateral EUS-guided biliary drainage is feasible and effective in patients with hilar cholangiocarcinoma, and thus can be used as an alternative to percutaneous biliary drainage.Mahidol UniversityMedicineArticleSCOPUS10.3748/wjg.v21.i34.10045