Per oral dual-scope rendezvous technique for endoscopic bridging of complete pancreatic duct disruption

A 43-year-old man with a history of heavy alcohol consumption and recent acute pancreatitis was admitted for recurrent epigastric pain and diagnosed as having a 4-cm pancreatic pseudocyst. Endoscopic retrograde cholangiopancreatography (ERCP) showed a pancreas divisum with total obstruction of the main pancreatic duct (MPD) in the mid-pancreas and no communication with the fluid collection. Minor papilla sphincterotomy was performed with placement of a 7-Fr plastic stent (Zimmon, Wilson-Cook, Winston-Salem, North Carolina, USA) in the pancreatic duct. Endoscopic ultrasound-guided cystogastrostomy was carried out (Pentax EG3860UT, Hamburg, Germany) and a single, 10-Fr double-pigtail stent was placed.