A 33-year-old woman had previously undergone laparoscopic excision of a congenital choledochal cyst and Roux-en-Y choledochojejunostomy. Four months later, she developed recurrent fever and jaundice and underwent percutaneous cholangioscopy, but the procedure failed to access the obstructed bile duct. Then, percutaneous transhepatic cholangiodrainage (PTCD) was performed, and magnetic resonance cholangiopancreatography revealed a significant anastomotic stricture. A short-type single-balloon enteroscope with a transparent cap and a balloon overtube was proceeded smoothly to the blind end of the afferent loop (Video 1). Under X-ray fluoroscopic guidance, a scar depression was seen in the jejunal wall near the hepatic hilum (Fig. 1 a), which was revealed as a completely occluded anastomosis by PTCD tube angiography (Fig. 1 b). After repeated failed guidewire puncture attempts, a Smart knife tip was pressed against the scar depression, combined with a guidewire puncture of the scar, allowing the guidewire to eventually enter the bile duct (Fig. 1 c, d). Conventional balloon dilation could not pass the stricture, so a stent retriever was used through repeated drilling and advancement over the guidewire, ultimately successfully dilating the tract (Fig. 1 e). This was followed by 6 mm balloon dilation and successful dilation confirmed by fluoroscopy (Fig. 1 f, g), with endoscopic confirmation of good dilation results (Fig. 1 h). Finally, two plastic stents (8. 5 Fr × 7 cm and 7 Fr × 7 cm) were placed in the right and left hepatic ducts (Fig. 1 i). The postoperative PTCD volume decreased significantly, and the bilirubin and liver enzymes decreased markedly. The patient was discharged uneventfully on postoperative day 2. At 2-month follow-up, the patient was asymptomatic. In our case, the bile duct jejunostomy was completely occluded, making guidewire puncture very difficult, and common dilators could not pass through the lumen of the guidewire puncture. This case demonstrates that smart knife-assisted guidewire puncture combined with stent retriever expansion can safely and effectively puncture and dilate strictures, restoring anastomotic patency. EndoscopyUCTNCodeTTT₁AR₂AJ Article published online: 04 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
Qu et al. (Wed,) studied this question.