Post written by Yuka Kawazoe, MD, from the Department of Gastroenterology, Kameda Medical Center, Kamogawa, Japan.

This video presents a case that demonstrates the use of an uneven double-lumen cannula combined with a percutaneous rendezvous technique to achieve pancreatic duct access in a patient with complex postoperative anatomy.

We chose to showcase this video because it illustrates a novel application of the pancreatic guidewire-assisted biliary cannulation technique using an uneven double-lumen cannula. This device helps stabilize the papilla, making it easier to align with the bile duct axis and facilitating biliary cannulation. Although this technique has been reported to improve success rates and reduce procedure time in cases of difficult biliary access, its use in pancreatic duct cannulation with a double-guidewire approach is rarely described, to our knowledge.

In this case, we successfully applied the technique to access the pancreatic duct in a patient with particularly complex postoperative anatomy. By combining it with the percutaneous rendezvous approach, we were able to overcome the challenges posed by altered anatomy and a postoperative pancreatic fistula.  

We hope this approach can serve as a useful option for achieving pancreatic duct access in challenging cases where conventional methods are unsuccessful. 

Photograph of the tip of the uneven double-lumen catheter (Uneven Double Lumen Cannula; PIOLAX Medical Devices, Yokohama, Japan). Two guidewires exit through separate lumens: one from the distal tip and the other from a proximal opening near the tip.

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