Pancreatic ductal drainage by endoscopic ultrasound-assisted rendezvous technique for pain caused by ductal stricture with chronic pancreatitis.

With the advances in echoendoscopes, the frontier of therapeutic endoscopic ultrasonography (EUS) is expanding. A 50-year-old male presented to us with unrelenting pain following an episode of alcoholic pancreatitis. Imaging studies revealed evidence of pancreatic ductal hypertension with a pseudocyst in the head of the pancreas. Following unsuccessful attempts at drainage of the pancreatic duct (PD) via the minor or major papilla at endoscopic retrograde cholangiopancreatography, he underwent endoscopic ductal drainage with the EUS-assisted rendezvous technique. The PD was punctured under the guidance of EUS. A guidewire was then introduced into the PD and was guided into the duodenal lumen through the minor papilla. The tip of the guidewire was grasped with forceps coming out of a duodenoscope introduced instead of the echoendoscope. A pancreatic stent was inserted over the guidewire across the minor papilla. After the endoscopic pancreatic stenting, the patient achieved symptomatic relief.