EUS-guided Gastrojejunostomy facilitated EUS-guided Pancreatic Duct Drainage with a Rendezvous Technique for Post-Whipple PancreaticoJejunal Stenosis

Abdullah Abbasi; Saurabh Chandan; Sagar Pathak; Maham Hayat; Natalie Cosgrove; Deepanshu Jain; Kambiz K. Kadkhodayan; Dennis Yang; Muhammad K. Hasan; Mustafa Arain

doi:10.1016/j.vgie.2026.09.004

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EUS-guided Gastrojejunostomy facilitated EUS-guided Pancreatic Duct Drainage with a Rendezvous Technique for Post-Whipple PancreaticoJejunal Stenosis

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EUS-guided Gastrojejunostomy facilitated EUS-guided Pancreatic Duct Drainage with a Rendezvous Technique for Post-Whipple PancreaticoJejunal Stenosis

Abdullah Abbasi, Saurabh Chandan, Sagar Pathak, Maham Hayat, Natalie Cosgrove, Deepanshu Jain, Kambiz K. Kadkhodayan, Dennis Yang, Muhammad K. Hasan and Mustafa Arain

VideoGIE : an official video journal of the American Society for Gastrointestinal Endoscopy

09/10/2026

DOI: 10.1016/j.vgie.2026.09.004

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Abstract

Pancreaticojejunostomy stenosis (PJS) is a recognized adverse event after pancreatic surgery. Endoscopic management is often technically challenging due to surgically altered anatomy. We describe a novel dual-modality interventional endoscopic ultrasound (EUS) approach utilizing EUS-guided gastrojejunostomy (EUS-GJ) as a conduit for EUS-guided pancreatic rendezvous and bridge to definitive therapy of PJS. A 32-year-old female with prior pylorus-preserving pancreaticoduodenectomy presented with recurrent acute pancreatitis. Magnetic resonance cholangiopancreatography suggested a PJS. Initial anterograde double balloon enteroscopy failed due to reach the PJ anastomosis. A free-hand electrocautery-assisted EUS-GJ was created using a 20 × 10 mm lumen-apposing metal stent. Four weeks later, EUS-guided pancreatic rendezvous was performed through the gastrojejunal conduit using a transpancreatic approach with guidewire-assisted dilation and pancreatic stent placement. Successful access across the PJS was achieved with balloon dilation and pancreatic stent placement using an over the wire flossing technique. On follow-up, the anastomosis was patent. At 2-year follow-up, the patient remained asymptomatic without recurrent pancreatitis. EUS-guided gastrojejunostomy can facilitate pancreatic duct rendezvous and serve as a bridge to definitive therapy in patients with PJS and complex surgical anatomy. This approach may provide a minimally invasive alternative in carefully selected patients.

Endoscopic ultrasound-guided gastrojejunostomy

Endoscopic ultrasound-guided rendezvous

Interventional endoscopic ultrasound

Pancreaticojejunostomy stenosis

Recurrent acute pancreatitis

Details

Title: Subtitle: EUS-guided Gastrojejunostomy facilitated EUS-guided Pancreatic Duct Drainage with a Rendezvous Technique for Post-Whipple PancreaticoJejunal Stenosis
Creators: Abdullah Abbasi - University of Iowa
Saurabh Chandan - Houston Methodist
Sagar Pathak - Loma Linda University
Maham Hayat - AdventHealth Orlando
Natalie Cosgrove - AdventHealth Orlando
Deepanshu Jain - AdventHealth Orlando
Kambiz K. Kadkhodayan - AdventHealth Orlando
Dennis Yang - AdventHealth Orlando
Muhammad K. Hasan - AdventHealth Orlando
Mustafa Arain - AdventHealth Orlando
Resource Type: Journal article
Publication Details: VideoGIE : an official video journal of the American Society for Gastrointestinal Endoscopy
DOI: 10.1016/j.vgie.2026.09.004
ISSN: 2468-4481
eISSN: 2468-4481
Publisher: Elsevier Inc
Language: English
Electronic publication date: 09/10/2026
Academic Unit: Internal Medicine
Record Identifier: 9985236318502771

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