Actual technique of hybrid rendezvous technique.

a, The intrahepatic bile duct was punctured under EUS guidance, followed by guidewire placement into the bile duct through the needle. b, Dilation of the fistula using a 6-French bougie dilator (red line), followed by guidewire manipulation into the duodenum through the ampulla with improved pushability and torqueability of the guidewire., c, The EUS scope was removed, keeping the guidewire and dilator in place. d, A duodenal scope was inserted into the duodenum and the EUS-placed guidewire was retrieved through the scope with a snare or loop cutter. During the retrieval, the guidewire could be manipulated through the dilator to assist the retrieval. e, A deep biliary cannulation (yellow line) was achieved over the EUS-placed guidewire. f, The dilator remained at the fistula until the completion of the originally planned therapeutic procedure.