Endoscopic ultrasound-directed transgastric ERCP facilitating extensive ampullectomy in Roux-en-Y gastric bypass patient

A 71-year-old woman with a history of BRCA2 + ovarian cancer and Roux-en-Y gastric bypass was incidentally found to have transiently elevated cholestatic liver function tests. Magnetic resonance cholangiopancreatography (MRCP) demonstrated intra- and extrahepatic dilatation to the level of the pancreatic head but no apparent stone or mass. A contrast-enhanced abdominal computed tomography (CT) scan identified a 26-mm ampullary neoplasm ([Fig....