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excludes the biliary tract from conven− tional endoscopic retrograde cholangio− pancreatography (ERCP) [1± 3]. However, the 200−cm−long double−balloon entero− scope (DBE) facilitates intubation of the afferent Roux−en−Y limb and maintains its position in front of the biliodigestive anastomosis. The 2.8−mm working chan− nel allows for the introduction of conven− tional accessories, provided they have 230 cm length available. Choledochojeju− nostomy balloon dilation using DBE was first reported after living donor liver transplantation [4]. In one multicenter study, two patients successfully under− went DBE ERCP and biliary balloon dila− tion after Roux−en−Y reconstruction [5]. We report two DBE interventions in one patient who had developed a hepaticoje− junostomy stricture after resection of the right lobe of the liver. This 72−year−old man with a Klatskin IIIa tumor under− went curative right hepatectomy and Roux−en−Y hepaticojejunostomy in 2004. Two years later, he presented with cho− langitis and dilatation of the intrahepatic biliary tree in the remaining left liver without any evidence of tumor recur− rence on magnetic resonance imaging. With the patient under general anesthe− sia, we reached the hepaticojejunostomy using the Fujinon EN−450T5 therapeutic DBE (Fujinon Corporation, Saitama−Shi, Saitama, Japan). The anastomosis was im− pacted with sludge entrapped in remain− ing sutures (l" Figure 1). It was cannulat− ed with a sclerosing needle catheter to perform cholangiography (l" Figure 2). The anastomotic stricture was dilated up to 6 mm using an esophageal dilation bal− loon, leading to swift clearance of intra− hepatic contrast (l" Figure 3). The cholan− gitis recurred 5 months later as a result of occlusion of the hepaticojejunostomy. During a second DBE procedure we cre− ated a new orificium with a sclerosing needle (l" Figure 4). The anastomosis was dilated over a guide wire, and two 7− Fr biliary stents (12 cm and 9 cm) were introduced through the DBE into the left hepatic branch to avoid rapid stenosis (l" Figure 5, l" 6). We used a nasobiliary The use of the double−balloon enteroscope for endoscopic retrograde cholangiopancreatography and biliary stent placement after Roux−en−Y hepaticojejunostomy

endoscopy

The use of the double-balloon enteroscope for endoscopic retrograde cholangiopancreatography and biliary stent placement after Roux-en-Y hepaticojejunostomy