A translumenal access system includes a translumenal access catheter, a trocar, and one or more guidewires. The trocar may be introduced through adjacent tissue layers, typically from an endoscope, and the translumenal access catheter introduced through the resulting penetration over the trocar. A balloon on the catheter may be used to dilate the penetration, and an enlarged distal portion of the balloon may be used to draw the tissue layers into apposition. The first stent may be exchanged for the trocar and a second stent may be introduced through a side port on the access catheter. The stents may be then used to introduced catheters or other interventional tools, optionally for delivering one or more stents to the enlarged tissue penetration.