A duodenal obstruction engulfing the papilla A, did not allow successful endoscopic retrograde cholangiopancreatography, EUS-guided rendezvous procedure, and enteral stent placement. B, Endoscopic choledochoduodenostomy was successfully completed to relieve the biliary obstruction. Arrow points to the lumen apposing stent; arrowheads point to a plastic pigtail stent. C, An endoscopic gastrojejunostomy was successfully completed to treat the duodenal obstruction. Arrows point to the electrocautery-enhanced lumen-apposing metal stent.