Preoperative decompression and diagnosis of pancreatic head adenocarcinoma in a patient with Roux-en-Y gastric bypass by means of EUS-guided gastric pouch hepaticogastrostomy

A 74-year-old woman with prior Roux-en-Y gastric bypass (RYGB) presented to an outside facility with jaundice, anorexia, and weight loss. Her serum total bilirubin was 13 mg/dL; abdominal CT showed a pancreatic head mass. She was referred for EUS/ERCP to decompress the biliary system and provide a diagnosis.

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