title: Benign Biliary Strictures Treated with Fully Covered Metallic Stents in Patients with Surgically Altered Anatomy Using Double Balloon Enteroscopy.
abstract: BACKGROUND
  Surgically altered anatomy complicates endoscopic procedures of the pancreaticobiliary tree. Biliary strictures have been managed using percutaneous transhepatic techniques.
  
  
  METHODS
  In recent years device-assisted enteroscopy (e.g., double balloon enteroscope [DBE]) has been used to gain access to the common bile duct. The length of the scope and its narrow, 2.8-mm working channel limit the use of standard endoscopic retrograde cholangiopancreatography (ERCP) devices. Therefore, shorter enteroscopes for ERCP have been developed. A fully covered self-expandable metallic stent (fcSEMS) cannot be used through the narrow channel. In conventional anatomy, benign biliary strictures have been treated using fcSEMS, requiring fewer endoscopies compared with multiple plastic stenting.
  
  
  RESULTS
  Here we report the first case of fcSEMS deployment through the working channel of a novel, long DBE with a 3.2-mm working channel, and 2 cases with the conventional narrow-channel DBE, using the rendezvous technique, with fcSEMS insertion on a wire running along the enteroscope.
  
  
  CONCLUSIONS
  These new techniques, here used on benign biliary strictures, are described in detail.
authors.affiliation: Gastroenterological Surgery, University of Helsinki and Helsinki University Hospital , Helsinki, Finland .
authors.forename: Carola
authors.initials: C
authors.lastname: Haapamäki
authors.affiliation: Gastroenterological Surgery, University of Helsinki and Helsinki University Hospital , Helsinki, Finland .
authors.forename: Marianne
authors.initials: M
authors.lastname: Udd
authors.affiliation: Gastroenterological Surgery, University of Helsinki and Helsinki University Hospital , Helsinki, Finland .
authors.forename: Leena
authors.initials: L
authors.lastname: Kylänpää
mesh_terms: D000368:Aged; D000714:Anastomosis, Surgical; D001652:Bile Ducts / Q000601:surgery; D001651:Cholestasis, Extrahepatic / Q000209:etiology / Q000628:therapy*; D003137:Common Bile Duct Diseases / Q000209:etiology / Q000628:therapy*; D058582:Double-Balloon Enteroscopy / Q000295:instrumentation / Q000379:methods*; D005260:Female; D005763:Gastroenterostomy; D006801:Humans; D007583:Jejunum / Q000601:surgery; D016031:Liver Transplantation; D008297:Male; D008875:Middle Aged; D016577:Pancreaticoduodenectomy; D011183:Postoperative Complications / Q000628:therapy*; D000069322:Self Expandable Metallic Stents