A 51-year-old man with a history of pancreaticoduodenectomy was scheduled to undergo endoscopic retrograde cholangiopancreatography (ERCP) with biliary stent placement for biliary-enteric anastomotic strictures. During the ERCP procedure, the endoscope was smoothly advanced to the region of the biliary-enteric anastomosis; however, the anastomotic stoma could not be located (Fig. 1). It was suspected that the biliary-enteric anastomosis might be situated behind the mucosal folds, making it invisible under the standard endoscopic view. A peroral cholangiopancreatoscope (9 Fr) was then introduced for further exploration (Fig. 2). A pinhole-like anastomotic stoma was visualized behind the mucosal folds using a cholangiopancreatoscope, and the guidewire (0. 035 in) was successfully inserted into the bile duct via this opening (Fig. 3). Then, the cholangiopancreatoscope was removed for further steps using a standard scope (Video 1). A needle knife was used to perform a 1–2 mm precut of the stoma (Fig. 4). Subsequently, an 8-mm diameter dilation balloon was employed to dilate the biliary-enteric anastomosis smoothly, followed by the successful placement of two plastic biliary stents (Fig. 5). The biliary stents were removed 8 months postoperatively. A follow-up examination 1 year after surgery showed no intrahepatic biliary dilation and no stricture at the biliary-enteric anastomosis. ERCP-guided biliary stent placement is the preferred treatment modality to patients with benign biliary strictures 1. In this case, the biliary-enteric anastomosis was located behind the mucosal folds, which was beyond the effective visual field. The authors innovatively utilized the peroral cholangiopancreatoscope, taking advantage of its excellent passability in narrow spaces and its capacity to expand the visual field. The probe navigated around the mucosal folds, ultimately facilitating successful cannulation. Thanks to its slender scope and real-time visualization capability, peroral cholangiopancreatoscopy has been further expanded to ERCP cannulation by some scholars, who have consequently developed ERDC technology 2, enabling radiation-free visualized precision cannulation. EndoscopyUCTNCodeCCL₁AZ₂AZ EndoscopyUCTNCodeTTT₁AR₂AL EndoscopyUCTNCodeTTT₁AR₂AG Article published online: 17 February 2026 © 2026. The Author (s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution License, permitting unrestricted use, distribution, and reproduction so long as the original work is properly cited. (https: //creativecommons. org/licenses/by/4. 0/). Georg Thieme Verlag KG Oswald-Hesse-Straße 50, 70469 Stuttgart, Germany
Zou et al. (Tue,) studied this question.