Peroral cholangioscopy-guided lithotripsy using a novel thin cholangioscope under balloon enteroscopy for Roux-en-Y anastomosis

Stone extraction using endoscopic retrograde cholangiopancreatography (ERCP) is less invasive than surgical procedures. However, stone extraction in patients with surgically altered anatomy, such as those who have undergone a Roux-en-Y procedure, is challenging. Although balloon enteroscopy is useful for such cases, there is still room for improvement [1] [2]. Peroral cholangioscopy (POCS)-guided lithotripsy can aid in the extraction of stones that are difficult to remove [3] [4]. However, performing POCS-guided lithotripsy under balloon enteroscopy is difficult because cholangioscopes have an approximate diameter of 10 Fr and cannot pass through the forceps channel of the balloon enteroscope. This report describes a patient with a Roux-en-Y anastomosis who was successfully treated with POCS-guided lithotripsy using a novel thin cholangioscope under balloon enteroscopy.