Recanalization for Tight Bile Duct-Jejunum Anastomosis Stricture Using Peroral Transliminal Cholangioscopy (with...

Recently, due to improvement of imaging modality, malignant tumor such as pancreatic or bile duct cancer can be detected at earlier stage. Therefore, the frequency of surgical treatment may be increasing. According to this background, benign biliary stricture in anastomosis site may also be increasing. This complication can lead to repeated cholangitis, obstructive jaundice, or liver abscess. Traditionally, interventional radiology such as percutaneous transhepatic biliary drainage (PTCD) or surgical re-anastomosis may be the first choice of treatment for benign biliary stricture in anastomosis site. Recently, double balloon enteroscopy-assisted endoscopic retrograde cholangiopancreatography (DB-ERCP) has emerged. This relatively novel procedure has less invasiveness compared with PTCD or surgical re-anastomosis. However, DB-ERCP has also several disadvantages such as long procedure time or low technical success rate if DB-ERCP is performed by non-expert hands. On the other hand, endoscopic ultrasound-guided biliary drainage has been developed as alternative biliary drainage technique. More recently, novel transluminal approach for biliary tract through endoscopic ultrasound-guided transluminal drainage route has been reported using digital single-operator cholangioscope. We herein report technical tips for peroral transluminal cholangioscopy using digital single-operator cholangioscope, and successfully performed recanalization for tight stricture of bile duct-jejunum anastomosis.