Endoscopic ultrasound-guided rendezvous manoeuvre is an alternative method of treatment for patients with complicated chronic pancreatitis, especially when endoscopic retrograde cholangiopancreatography fails

A 42-year-old male patient with chronic pancreatitis secondary to alcohol consumption was admitted to our department with complaints of severe abdominal pain and weight loss of about 25 kg within the last 2 months. Abdominal contrast-enhanced computed tomography was performed, revealing a pseudocyst (43 × 45 mm) in the pancreatic head (Figures 1 A, B), which caused duodenal stenosis and communicated with the dilated main pancreatic duct (MPD). The patient was qualified for endoscopic treatment; however, endoscopic ultrasound (EUS) imaging revealed that the pancreatic pseudocyst was surrounded by extensive inflammatory infiltration involving the duodenal wall. EUS-guided transmural drainage of the pseudocyst was not suitable because the distance between the lumen of the gastrointestinal tract and the lumen of the pseudocyst exceeded 30 mm, as shown in EUS imaging. During the endoscopic examination, inflammatory infiltration of the duodenal wall that narrowed the lumen of the gastrointestinal tract lumen was detected. It was also impossible to introduce the endoscope into the descending duodenum in order to localize the major duodenal papilla during endoscopic retrograde cholangiopancreatography (ERCP) for subsequent endoscopic transpapillary drainage of the pancreatic pseudocyst. Therefore, we decided to perform the EUS-guided rendezvous manoeuvre. A 19G needle was used to perform an EUS-guided puncture of the dilated MPD across the posterior wall of the gastric antrum. Contrast was administered via the needle, and this filled the MPD along its entire length (antegrade pancreatography), revealing partial disruption of the MPD within the pancreatic head, which resulted to leakage of contrast agent into the lumen of the pancreatic pseudocyst (Figure 1 C). The needle was used for transmural/transgastric introduction of a guidewire into the MPD, and the distal tip of the guidewire was placed within the duodenal bulb after passing it through the major duodenal papilla (Figures 1 D, E). The echoendoscope was then switched to a duodenoscope with the guidewire remaining in the transmural position within the lumen of the MPD and the duodenum. The duodenoscope was introduced into the duodenal bulb and the guidewire was grasped using endoscopic forceps. The MPD was catheterized selectively via the duodenal papilla (Figure 1 F). A 12-cm, 7-Fr pancreatic stent was then introduced along the guidewire, and its distal end was placed within the pancreatic tail so as to...


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