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Endoscopic retrograde cholangiopancreatography (ERCP) in patients with a Rouxen-Y gastric bypass remains very challenging. Placement of a large biliary stent is typically not feasible using single-balloon enteroscopy. We describe the use of a fully covered, metal esophageal stent to access the excluded stomach and perform ERCP. A 49-year-old woman who had undergone Roux-en-Y gastric bypass surgery and cholecystectomy in 1999 was referred in July 2009 for evaluation of chronic pancreatitis associated with abdominal pain since 2007.Magnetic resonance cholangiopancreatography (MRCP) showed atrophic fibrotic change of the pancreas with irregularity of the pancreatic duct, biliary dilatation, and mild dehiscence of the staple line between the gastric remnant and the excluded stomach. An initial endoscopy confirmed a defect in the staple line and using a Hydra wire (Boston Scientific, Natick, Massachusetts, USA), the tract was dilated using a balloon

ERCP in Roux-en-Y gastric bypass: creation of an antegrade gastrogastric conduit using a fully covered metal esophageal stent