This video case report presents a patient with an invasive pancreatic mass and a history of Roux-en-Y gastric bypass surgery who underwent single-session endoscopic ultrasound-directed transgastric ERCP for tissue sampling and biliary stenting with subsequent maintenance of the newly established gastrogastrostomy. The demonstrated technique enables spectrum of endoscopic interventions in gastric bypass patients by facilitating a direct endoscopic passage through the reconnected stomach. Importantly, the method carries a risk of weight regain by essentially reversing the bypass. However, this can be an actual desire in selected cases, e.g., oncologic patients, making it a favorable choice over other alternatives.
Keywords: EDGE; ERCP; Endoscopic ultrasound; Gastric bypass; Gastrogastrostomy; Pancreatic cancer; Roux-en-Y.