Rendezvous-assisted endoscopic retrograde pancreatography using a dual-wire balloon technique for stenotic pancreaticojejunostomy in post-Whipple anatomy.

ABSTRACT:

Background and aims

Pancreatic duct (PD) stones and a stenotic pancreaticojejunal anastomosis (PJA) can make ERCP highly challenging, especially in post-Whipple anatomy. EUS-assisted rendezvous (RV) may serve as a salvage approach, but severe stenoses can prevent guidewire passage. We describe a novel dual-wire balloon technique to achieve PD drainage in this setting.

Methods

A 67-year-old man with Zollinger-Ellison syndrome and previous Whipple surgery presented with recurrent pancreatitis. Imaging revealed PD stones impacted at the PJA. Multiple enteroscopy-assisted ERCPs and an initial EUS-assisted RV failed. On repeat EUS-assisted RV, a 22-gauge needle was used to puncture the PD, and a 0.018-inch guidewire was advanced antegrade into the jejunum. Standard devices could

SUBMITTER: Vanek P 

PROVIDER: S-EPMC12921581 | biostudies-literature | 2026 Feb

REPOSITORIES: biostudies-literature