LAUSR

An 18-year-old female was hospitalized for chronic pancreatitis of unknown origin. No history of alcohol abuse and hereditary diseases were found. Enhanced computed tomography (CT) and magnetic resonance cholangiography revealed dilated pancreatic duct system and abnormal pancreatic tissue incompletely wrapping around the second portion of the duodenum (▶Fig. 1, ▶Fig. 2). Endoscopic retrograde pancreatography (ERP) with intended minor papilla cannulation was attempted and yet failed due to the polypoid nodular papilla (▶Fig. 3). Rendezvous-assisted ERP (RV-ERP) was performed (▶Video 1). The main pancreatic duct was punctured with 19-G needle (Echotip Ultra, Cook, Limerick, Ireland) via gastric access. Contrast injection showed that the dilated dorsal pancreatic duct opened into the minor papilla without communication with the ventral duct, and irregular side branches partially encircled the duodenum, which confirmed diagnosis of annular pancreas (AP) and complete pancreas divisum (PD) (▶Fig. 4). Then a 0.035-inch guidewire (Jagwire, Boston Scientific, Marlborough, USA) was advanced from the pancreatic duct into the duodenum and the echoendoscope was exchanged for a duodenoscope, leaving the coiled guidewire in place (▶Fig. 5). Using a snare, the E-Videos