Treatment of a bile duct leak with ERCP double-balloon enteroscopy in a patient with Roux-en-Y reconstruction.

A 75-year-old man previously presented with gastric outlet obstruction caused by a pyloric peptic stricture, which did not respond to balloon dilation. He required surgical treatment with a Roux-en-Y reconstruction in 2011. Four years later, he presented an episode of cholecystitis, and an open partial cholecystectomy was performed after discovery of gallbladder empyema. Postoperative biliary leakage occurred, with drainage of 350mL/day through external drains. A magnetic resonance cholangiopancreatography confirmed the presence of a biliary collection and a cystic duct leak (●" Fig.1). Endoscopic retrograde cholangiopancreatography (ERCP) was attempted using double-balloon enteroscopy to reach the native papilla through the afferent limb. Cannulation with a Soehendra BII sphincterotome was successful, and a Jagwire was introduced into the bile duct. Contrast material was then injected to confirm the cystic duct leak (●" Fig.2a). A small sphincterotomy was performed, and a 7Fr×10cm plastic stent was placed in the bile duct (●" Fig.2b,●" Video 1). After the procedure the bile drainage decreased to 30mL/day, and disappeared