Single-balloon Enteroscopy Assisted Endoscopic Retrograde Cholangiopancreatography with the Rendezvous Technique

Endoscopic retrograde cholangiopancreatography (ERCP) in patients with surgically altered upper gastrointestinal anatomy such as a Roux-en-Y anastomosis is challenging. The use of balloon-assisted enteroscopy allows evaluation of the surgically excluded segment, access to the biliopancreatic tract and performance of endoscopic therapy. A 79-year-old female patient, with history of cholecistectomy (2005) and total gastrectomy with Roux-en-Y anastomosis for gastric cancer (pT2N0M0, 2007), suffered from recurrent episodes of cholangitis (2012). Abdominal ultrasonography revealed pronounced bile duct dilation (20mm) caused by a large gallstone (17mm) in the distal third of the common bile duct. After a failed standard ERCP, a percutaneous transhepatic biliary drainage (PTBD) was initially performed to relieve the obstruction. However, stone extraction was not accomplished. Therefore, she was referred to us for SBE-assisted ERCP, which was performed using a rendezvous technique, since there was a previously placed PTDB. The SBE (SIF-Q180 Olympus Medical Systems, Tokyo, Japan) was advanced to the afferent limb up to the papilla, where externalization of the percutaneously inserted guidewire was observed. A