Stenosis of Hepaticojejunal Anastomosis with Intrahepatic Lithiasis: Treatment with Single-Balloon Enteroscopy-Assisted ERCP

kyo, Japan) with a transparent cap attached at its tip. After identification of the Roux-en-Y anastomosis, the afferent limb was intubated, followed by progression to the hepaticojejunal anastomosis. A severe stricture of the anastomosis was identified (Fig. 1). A 0.035-inch guidewire (METII-35-600E, Tracer Metro® DirectTM Wire Guide, Cook®, Bloomington, IN, USA) was passed through the stricture followed by a sphincterotome (CCPT-25ME, Classic Cotton® CannulaTome®, Cook®). Upon contrast injection, dilation of the intrahepatic ducts was evident. Dilation with a 6to 8-mm through-the-scope balloon (34106PRO, Endo-Flex®, Düsseldorf, Germany) was then performed (Fig. 2, 3) with immediate spontaneous drainage of multiple small calculi. The intrahepatic bile ducts were explored with a balloon catheter, but no more calculi were identified. The patient was discharged on the second day after the procedure and did not present additional episodes of acute cholangitis after a 6-month follow-up. ERCP is an essential therapeutic technique for a wide range of pancreatobiliary conditions and presents a 90– 95% success rate in patients with native gastric and pancreaticoduodenal anatomy [1]. In Roux-en-Y surgical reconstruction (hepaticojejunostomy and choledochojejunostomy, gastric bypass surgery, or post-Whipple surgery), ERCP is often unsuccessful because of the in