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| Long-type double-balloon enteroscopy-assisted ERCP using hand-made accessories in Roux-en-Y hepaticojejunostomy (with video) |
| Min Jae Yang # , Ah Reum Kim # , Jae Chul Hwang, Byung Moo Yoo, Jin Hong Kim ∗ |
Department of Gastroenterology, Ajou University School of Medicine, Suwon, South Korea
∗ Corresponding author.
E-mail address: jinhkim@ajou.ac.kr (J.H. Kim).
# Contributed equally. |
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Abstract Short-type balloon enteroscope-assisted endoscopic retrograde cholangiopancreatography (BE-ERCP) is becoming the procedure of choice for biliopancreatic disease treatment in patients with postoperative anatomy [1,2]. However, it has not yet been available in many countries. Although a long-type balloon enteroscope with a 200-cm working length has been widely used for small bowel endoscopy, its use for ERCP was limited by the lack of commercially available extra-long accessories [3]. We hereby describe the successful use of hand-made ERCP accessories for long-type doubleballoon enteroscopy (DBE)-assisted therapeutic ERCP in a case with Roux-en-Y hepaticojejunostomy reconstruction and recurrent bilioenteric anastomotic stricture. A 73-year-old woman presented to our emergency department with a 5-day history of progressive worsening of right upper quadrant pain and jaundice. She had undergone a bile duct segmental resection, cholecystectomy, and Roux-en-Y hepaticojejunostomy 10 years prior for high-grade dysplasia of the common hepatic duct, and a percutaneous transhepatic cholangioscopy and balloon dilation 3 years prior for a benign bilioenteric anastomotic stricture and hepatolithiasis. Abdominal computed tomography showed focal wall thickening at the hepaticojejunostomy anastomotic site and diffuse dilation of the intrahepatic bile duct, which suggested a recurrent anastomotic stricture. Balloon dilation, bile duct clearance, and multiple plastic stenting through long-type DBE-assisted ERCP were indicated. Hand-made ERCP accessories with working length ≥ 230 cm were prepared before the ERCP procedures.
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2021, Vol. 20 
