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This article discusses a medical procedure called Double EUS-guided bypass (DEB) that combines hepaticogastrostomy (HGS) and lumen-apposing metal stent duodeno-jejunostomy (LAMS-DJ) for the treatment of massive hepatolithiasis in patients who have previously undergone Roux-en-Y hepaticojejunostomy (RYHJ). The procedure involves using endoscopic ultrasound (EUS) to guide the placement of stents and perform lithotripsy to clear the bile ducts. The authors report that the procedure was successful in achieving duct clearance without any adverse events. They suggest that DEB may be a viable option for addressing larger disease burdens in patients with RYHJ, while minimizing the risk of complications. [Extracted from the article]