A 59-year-old female with hilar cholangiocarcinoma and indwelling biliary stents was admitted for cholangitis and gastric outlet obstruction. ERCP failed due to neoplastic duodenal stenosis. The patient underwent EUS-gastroenterostomy (GE) with a 20 mm LAMS, and EUS-directed transduodenal ERCP (EDDE) was attempted. However, access to the papillary region was not possible due to unfavorable angulation of the GE. A guidewire was passed through the duodenal stenosis in an antegrade manner toward the LAMS and then into the stomach through the LAMS. Using a rendezvous (RV) technique, the gastroscope was reintroduced alongside the guidewire, which was retrieved through the working channel. This maneuver allowed the gastroscope to advance efficiently through the LAMS up to the papillary region using double traction. ERCP was then successfully completed with placement of a new biliary stent