A novel ultrathin cholangioscope for endoscopic ultrasound-guided antegrade intervention in patients with Roux-en-Y hepaticojejunostomy

Cholangitis can occur after biliary reconstructive surgery and is most commonly caused by hepaticojejunostomy anastomotic strictures and bile duct stones [1]. Endoscopic ultrasound-guided antegrade treatment (EUS-AG) has recently been performed in cases where balloon enteroscopy-assisted endoscopic retrograde cholangiopancreatography (BE-ERCP) is difficult [2]. In EUS-AG, cholangioscopy is needed to obtain direct visual information on the anastomosis. However, it is often difficult to insert a cholangioscope in a significantly dilated fistula due to the narrowness of the intrahepatic bile ducts. We report the feasibility of a novel ultrathin cholangioscope (DRES Slim Scope; Japan Lifeline Co., Ltd., Tokyo, Japan) that has almost the same diameter as a standard ERCP catheter ([Fig. 1]).