Precut over a pancreatic stent using the marking method to aid biliary cannulation in a patient with Roux-en-Y reconstruction

Despite the remarkable development of balloon enteroscopy-assisted endoscopic retrograde cholangiopancreatography (ERCP), deep biliary cannulation in patients with surgically altered anatomy remains challenging [1] [2]. We report a case where biliary cannulation was successfully achieved via precutting over a pancreatic stent using the marking method [3].