A 46-year-old man had undergone Roux-en-Y choledochojejunostomy for pancreatobiliary maljunction at 35 years of age. The patient was given a diagnosis of cholangitis with hepatolithiasis and was admitted to the hospital. A long-type single-balloon enteroscope was difficult to insert to the choledochojejunostomy anastomosis (CJA) . A percutaneous approach was attempted, but precluded by the intestine in the puncture route. Transgastrohepatic puncture of the bile duct (B2) was done under endoscopic ultrasound (EUS) guidance. Cholangiography was performed and revealed several filling defects, suggesting stones up to 20 mm in diameter. The CJA was dilated with a balloon, and the stones were then removed in an antegrade fashion with the use of a balloon catheter for stone removal. The stones were completely removed after 2 sessions of treatment, with no procedural complications. This procedure is useful in patients in whom transanastomotic and percutaneous procedures are difficult to perform.
