Endoscopic ultrasound-guided pancreatic duct drainage with a two-step puncture technique for a non-dilated pancreatic duct

Endoscopic ultrasound-guided pancreatic duct drainage (EUS-PD) has emerged as an option in patients with failure of standard transpapillary endoscopic retrograde access to the pancreatic duct (PD) or surgically altered anatomy [1]. The ductal pressure of a non-dilated PD is often low and the duct can be easily compressed by the tip of the needle, thus requiring a technical tip to handle this situation [2]. We describe successful EUS-PD with a two-step puncture technique for a non-dilated PD after pancreaticoduodenectomy as a result of solid pseudopapillary neoplasm ([Video 1]).