EUS-guided Rendezvous in Gastric Bypass: a Double-Edged Transgastric ERCP

Text Introduction: EUS-directed trans-Gastric Intervention (EDGI) via LAMS into the excluded stomach has not yet been reported for biliary rendezvous.Case: Symptomatic CBD stone in Roux-en-Y gastric bypass female. A 20x10 mm LAMS is placed for single-session EDGE. Wire-guided cannulation of a small papilla fails. EUS-rendezvous is chosen instead of pre-cut in a high-risk patient with hostile papillary anatomy. Duodenoscope is exchanged for the echoendoscope. CBD is 19G-punctured and guidewire passed antegrade across the papilla. Sphincterotomy with a home-made mono-rail sphincterotome with the echoendoscope allows wireless scope exchange, for a final balloon sweep with the duodenoscope. Comment: In hostile duodenal anatomy, pre-cut may be avoided by rendezvous, even in EDGE.