title: Single Balloon Enteroscopy-Assisted ERCP Using Rendezvous Technique for Sharp Angulation of Roux-en-Y Limb in a Patient with Bile Duct Stones.
abstract: The acute angulation of Roux-en-Y (R-Y) limb precludes endoscopic access for endoscopic retrograde cholangiopancreatography (ERCP) even using a balloon enteroscopy. Here, we describe a case of successful single balloon enteroscopy (SBE)-assisted ERCP using a rendezvous technique in a patient with sharply angulated R-Y limb in a 79-year-old woman who had bile duct stones. Method. At first, a guidewire was passed antegradely through the major papilla after the needle puncture using percutaneous transhepatic biliary drainage technique. A hydrophilic guidewire with an ERCP catheter was antegradely advanced beyond the Roux limb. After a guidewire was firmly grasped by a snare forceps, it was pulled out of the body, resulting that the enteroscope could advance to the papilla. After papillary dilation, complete removal of bile duct stones was achieved without any procedure-related complication. In conclusion, although further study is needed, SBE-assisted ERCP using a rendezvous technique may have a potential for selected patients.
authors.affiliation: Department of Gastroenterology and Hepatology, Tokyo Medical University, Tokyo 160-0023, Japan.
authors.forename: Takao
authors.initials: T
authors.lastname: Itoi
authors.forename: Kentaro
authors.initials: K
authors.lastname: Ishii
authors.forename: Atsushi
authors.initials: A
authors.lastname: Sofuni
authors.forename: Fumihide
authors.initials: F
authors.lastname: Itokawa
authors.forename: Toshio
authors.initials: T
authors.lastname: Kurihara
authors.forename: Takayoshi
authors.initials: T
authors.lastname: Tsuchiya
authors.forename: Shujiro
authors.initials: S
authors.lastname: Tsuji
authors.forename: Junko
authors.initials: J
authors.lastname: Umeda
authors.forename: Fuminori
authors.initials: F
authors.lastname: Moriyasu