A 57-year-old male patient underwent pylorus-preserving pancreaticoduodenectomy for a pancreatic neuroendocrine tumor. Hepatic dysfunction and intrahepatic bile duct dilatation were indicated. A diagnosis of hepaticojejunostomy anastomotic stricture was made, and SBE-ERCP was thus performed but the anastomosis site could not be identified. The following day, EUS-HGS was performed, and a 7 Fr plastic stent (PS) was placed with the tip slightly beyond the anastomosis. Two months later, SBE-ERCP was performed again, and the bile duct was successfully intubated using the PS that was placed by EUS-HGS as a marker, and a FCSEMS was placed in the right intrahepatic bile duct for the anastomotic stricture. The PS and FCSEMS were removed 6 months after the surgery. The patient is under follow-up with no evidence of recurrence. Bile duct drainage using the EUS-guided rendezvous technique is a useful salvage method for cases in which ERCP is difficult, including those in which the hepaticojejunostomy anastomosis is difficult to identify.
