A novel method for endoscopic ultrasound-guided pancreatic rendezvous with a microcatheter.

A 69-year-old woman with chronic pancreatitis and recurrent pancreatic-type abdominal pain underwent computed tomography, which showed dilatation of the pancreatic duct. Subsequent endoscopic retrograde cholangiopancreatography revealed a fibrotic papillary stenosis preventing cannulation of the pancreatic duct. Endoscopic ultrasound (EUS)-guided rendezvous was attempted (●" Video 1). The pancreatic duct was punctured with a 19-gauge needle (Expect; Boston Scientific, Natick, Massachusetts, USA). A 0.025-inch angulated-tip guidewire (VisiGlide; Olympus America, Center Valley, Pennsylvania, USA) was then advanced into the pancreatic duct but could not pass through the stenosis to the duodenal lumen. Because of the possible risk for fragmentation of the guidewire during manipulation, the needle was removed and a 150-cm, 3-Fr microcatheter (Renegade Hi-Flo; Boston Scientific) was inserted into the pancreatic duct over the guidewire (●" Fig.1). The microcatheter was smoothly inserted and easily advanced to the prepapillary area, and the guidewire was removed (●" Fig.2). Contrast was injected to better define the cephalic duct (●" Fig.3). A 0.025-inch straight-tip guidewire was inserted through the microcatheter (●" Fig.4) and after manipulation was advanced through the stenosis into the duodenum (●" Fig.5). The pancreatic rendezvous was completFig.2 The microcatheter (arrow) has been advanced to the prepapillary area and the guidewire removed.