Endoscopic Ultrasound–Directed Transgastric Fine-Needle Aspiration in Diagnosis of Pancreatic Head Mass

Renal cell carcinoma is an aggressive malignancy, with distant metastases often diagnosed many years following radical nephrectomy. We describe a case of pancreatic metastasis in a patient with prior renal cell carcinoma and history of Roux-en-Y gastric bypass, diagnosed using endoscopic ultrasound-directed transgastric endoscopic retrograde cholangiopancreatography (ERCP) procedure. Our case demonstrates the utility of endoscopic ultrasound–directed transgastric ERCP to both diagnose and manage treatment of malignancy in patients with altered anatomy, as a minimally invasive alternative to ERCP.