A 64-year-old obese woman presented with sudden onset of abdominal pain and hematemesis. Physical exam was notable for tenderness in the right upper quadrant (RUQ) with a positive Murphy’s sign. Lab results showed elevated aspartate aminotransferase 291 U/L, alanine aminotransferase 231 U/L, and total bilirubin 2.3 mg/L. A RUQ ultrasound showed cholelithiasis. Total bilirubin increased to 4.3 m...

Since it was first described in 2001 [1], endoscopic ultrasound-guided choledochoduodenostomy (EUS-CDS) has been increasingly used as an alternative for biliary decompression after failed endoscopic retrograde cholangiopancreatography (ERCP). EUS-CDS has an overall technical success rate of more than 90% [2, 3], but puncturing the common bile duct (CBD) can be challenging in patients with hemob...

INTRODUCTION Sorafenib, a multikinase inhibitor as a standard of care for advanced hepatocellular carcinoma, may lead endothelial cells to an unstable state by blocking the signaling pathway of vascular endothelial growth factor receptor, which may result in the disruption of the architecture and integrity of the microvasculature, and eventually increase the risk of hemorrhage. Hemobilia is a r...

Since it was first described in 2001 [1], endoscopic ultrasound-guided choledochoduodenostomy (EUS-CDS) has been increasingly used as an alternative for biliary decompression after failed endoscopic retrograde cholangiopancreatography (ERCP). EUS-CDS has an overall technical success rate of more than 90% [2, 3], but puncturing the common bile duct (CBD) can be challenging in patients with hemob...