Endoscopic ultrasonography-guided drainage for patients with symptomatic obstruction and enlargement of the pancreatic duct

Figure 1 Patient with dilated pancreatic duct, recurrent pancreatitis, and pancreas divisum in whom endoscopic retrograde cholangiopancreatography has failed. A: After endoscopic ultrasonography-guided puncture and administration of contrast medium, imaging of the pancreatic duct under fluoroscopic control shows there is almost no outflow of contrast medium out of the minor papilla; B: The guide wire is advanced into the pancreatic duct and through and out of the minor papilla; C: After changing to a duodenoscope, the guide wire was identified and an extending papillotomy was performed using a conventional technique; D: An 11.5-Fr. prosthesis is placed into the minor papilla, with subsequent adequate outflow of contrast medium.