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In many instances, access to the main pancreatic duct or bile duct by standard endoscopic retrograde cholangio-pancreatography (ERCP) is difficult. Stanford therapeutic endoscopists have the expertise to provide alternative approaches to obtain access including using endoscopic ultrasound technology to access the ducts. With this approach, guidewires can be placed for rendezvous to facilitate ERCP, or in select cases, access and treatment of disease in the pancreatic duct can be performed entirely under endoscopic ultrasound guidance (also called EUS-guided anterograde cholangio-pancreatography).