Fig. 13. Under endoscopic ultrasound and X-ray guidance, a trans-gastric drainage with two double pigtails (10-Fr, 5 cm) was established. An immediate outflow from the pancreatic fluid collections into the stomach was appreciated. Once the first double pigtail is placed with cystotome, an over-the-wire sphincterotome can be employed to enlarge the gastric entry for the second pigtail which will stabilize the cysto-gastrostomy.
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