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HOME > Clin Endosc > Volume 59(2); 2026 > Article
Video of Issue Endoscopic ultrasound-guided internalization of external pancreatic fistula using balloon-targeted rendezvous technique
Sudipta Dhar Chowdhury1orcid, Santosh Babu K.B2orcid, Amith Viswanath1orcid, Reuben Thomas Kurien1orcid, Anoop John1orcid
Clinical Endoscopy 2026;59(2):313-314.
DOI: https://doi.org/10.5946/ce.2025.240
Published online: January 8, 2026

1Department of Medical Gastroenterology, Christian Medical College, Vellore, India

2Department of Interventional Radiology, Christian Medical College, Vellore, India

Correspondence: Sudipta Dhar Chowdhury Department of Medical Gastroenterology, Christian Medical College, Vellore 632004, Tamil Nadu, India E-mail: sudiptadharchowdhury@gmail.com
• Received: July 23, 2025   • Revised: August 7, 2025   • Accepted: August 11, 2025

© 2026 Korean Society of Gastrointestinal Endoscopy

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (https://creativecommons.org/licenses/by-nc/4.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

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External pancreatic fistulas (EPF) secondary to disconnected pancreatic duct syndrome (DPDS) present with complex management challenges, particularly when conservative measures fail.1,2 Herein, we describe a novel balloon-targeted endoscopic ultrasound (EUS)-guided rendezvous technique that overcomes the limitations of traditional internalization methods. Two patients with high-output, persistent EPF due to DPDS who were unresponsive to conventional treatment underwent this intervention. First, a guidewire was inserted through the percutaneous tract, after which the external EPF drain was removed. A 15 mm biliary stone extraction balloon (Olympus) was then advanced over the guidewire under fluoroscopic guidance and inflated within the fistulous tract using saline and contrast. On EUS, the inflated balloon appeared as a well-demarcated, anechoic, fluid-filled structure, enabling precise EUS-guided targeting. Using a 19-gauge fine needle aspiration cytology needle (ProCore; Cook Medical Inc.), the balloon was punctured from the stomach under EUS guidance, and a 0.035-inch guidewire (Olympus) was advanced externally through the fistulous tract. Over this wire, serial tract dilation was performed using a 6 Fr cystotome (Cook Medical Inc.) and 4 mm Hurricane RX biliary balloon catheter (Boston Scientific). A 10 Fr Sohendra biliary dilation catheter (Cook Medical Inc.) was then inserted into the tract, and a second guidewire was passed through and exteriorized. This was followed by the deployment of two 7 Fr, 5 cm double pigtail stents (Cook Medical Inc.). The complete technical procedure is shown in the accompanying video (Video 1).
Technical and clinical success was achieved in both patients without complications. The fistula output declined markedly within 24 hours, with complete closure observed within one week. At the six-month follow-up, both patients remained asymptomatic, with no evidence of recurrence or fluid collection. This balloon-targeted rendezvous technique offers several advantages, including a clear anatomical definition of the tract, a minimized risk of collateral tissue injury, and a reproducible target of known dimensions. Although further validation is required in larger patient cohorts, this method may be effective for selected patients with DPDS.
Video 1. Endoscopic ultrasound-guided internalization of external pancreatic fistula using balloon-targeted rendezvous technique. This video demonstrates the key technical steps of the novel balloon-targeted rendezvous approach for internalization of external pancreatic fistula.
A video related to this article can be found online at https://doi.org/10.5946/ce.2025.240.
  • 1. Fotoohi M, D'Agostino HB, Wollman B, et al. Persistent pancreatocutaneous fistula after percutaneous drainage of pancreatic fluid collections: role of cause and severity of pancreatitis. Radiology 1999;213:573–578.ArticlePubMed
  • 2. Uomo G, Molino D, Visconti M, et al. The incidence of main pancreatic duct disruption in severe biliary pancreatitis. Am J Surg 1998;176:49–52.ArticlePubMed

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        Endoscopic ultrasound-guided internalization of external pancreatic fistula using balloon-targeted rendezvous technique
        Clin Endosc. 2026;59(2):313-314.   Published online January 8, 2026
        DOI: https://doi.org/10.5946/ce.2025.240
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      Endoscopic ultrasound-guided internalization of external pancreatic fistula using balloon-targeted rendezvous technique
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