Tip attachment technique for double-balloon-enteroscopy-assisted endoscopic retrograde cholangiopancreatography

Abstract

A 73-year-old man was referred for treatment of choledocholithiasis. He had undergone partial gastrectomy with Roux-en-Y gastrojejunostomy for gastric carcinoma. Because of the long afferent loop, a double-balloon enteroscope (EC-450BI5) with soft transparent hood attached to the endoscope tip was used to gain access to the ductal anastomosis. However it was still difficult not only to reach the site of choledochojejunostomy, but also to selectively cannulate into the biliary duct during ERCP using DBE (DB-ERCP). We easily enhanced the common bile duct by fixing the ductal anastomosis using the soft transparent hood. Cholangiography showed multiple duct stones. ERCP was required to be performed four times in order to remove all the stones. Herein we present a case using DB-ERCP with tip attachment to successfully remove endoscopically common bile duct stones in a patient with partial gastrectomy and Roux-en-Y gastrojejunostomy.