Pancreatic duct drainage using EUS-guided rendezvous technique for stenotic pancreaticojejunostomy

Figure 1 Re-construction after subtotal stomach-preserving pancreaticoduodenectomy. A: Before the operation (after excision of extrahepatic bile duct and Roux-en-Y hepaticojejunostomy; B: After the operation, pancreaticojejunostomy and gastrojejunostomy were performed. Roux-en-Y hepaticojejunostomy was re-established.

Figure 2 Computed tomography (A) and and endoscopic ultrasonography (B) revealed a dilated pancreatic duct (white arrows).

Figure 3 Pancreatic duct drainage procedures using endoscopic ultrasonograph-guided rendezvous technique. A: Pancreatic duct puncture and pancreatography using endoscopic ultrasonography; B: Introducing the guidewire into the jejunum through the pancreatic duct and the stenotic anastomosis; C: After exchanging echoendoscope for oblique-viewing endoscope, the guidewire was withdrawn into the working channel; D: Balloon dilatation of the stenotic anastomosis; E: Placement of an endoscopic naso-pancreatic drainage tube.