This 66-years old man had a pancreatic head mass with a negative EUS biopsy. The plan initially was to find a path to the lesion without touching bowel, but at the time of the biopsy, the hepatic flexure was in the way. I then decided to use a deliberate transcolonic approach, but I was able to displace the hepatic flexure and go underneath it without piercing it.

The video describes the rest.