A 49-year-old patient underwent cholecystectomy and Roux-en-Y hepaticojejunal anastomosis (●" Fig.1) for Mirizzi’s syndrome. Jaundice, pruritus, choluria, and acholia developed 4 months later. The total serum bilirubin was 21mg/dL, and magnetic resonance cholangiopancreatography (MRCP) demonstrated intrahepatic bile duct dilation and anastomotic stricture. Double-balloon enteroscopy was perform...

Endoscopic ultrasonography (EUS)-guided antegrade bile duct stone treatment has been developed for patients with altered anatomy [1–5]. Here, we present a case of successful bile duct stone treatment via an EUS-guided hepaticogastrostomy (EUS-HGS) route in the setting of prior Roux-en-Y reconstruction. Direct peroral transhepatic cholangioscopyguided electronic hydraulic lithotripsy (EHL) and e...

BACKGROUND/AIMS Endoscopic extraction of bile duct stones is difficult and often complicated in patients with a Billroth II gastrectomy. We evaluated a simpler technique to achieve an adequate ampullary opening for the removal of choledocholithiasis using endoscopic papillary large balloon dilation (EPLBD) combined with a guidewire-assisted needle-knife papillotomy. METHODS Sixteen patients w...

papillary balloon dilation (EPBD) was proposed as an alternative to endoscopic sphincterotomy (EST) for opening the bile duct orifice to allow stone extraction with functional preservation of the biliary sphincter. Since its introduction in 1982, 1 EPBD has been widely performed because it is associated with lower bleeding and perforation risks compared to EST. 2-6 However, EPBD is more likely ...