A catheter for penetrating and dilating a passage from a first body lumen to a second body lumen comprises a catheter body, a tapered dilating tip at a distal end of the catheter body, a reciprocatable needle carried in a central passage of the catheter body, a deployable anchor carried near a distal end of the needle, and an advanceable blade carried in a slot at the distal end of the catheter body and advanceable in a track formed axially along the needle. The catheter can be used to penetrate adjacent luminal walls by first advancing the needle, and advancing the dilator over the needle followed by deploying the anchor, applying proximal tension to hold the adjacent tissue layers together, and then advancing the dilator with the exposed blade to fully dilate the passage.