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.