Self-expandable metal stent placement combining double balloon endoscopy with a percutaneous approach in a Roux-en-Y hepaticojejunostomy.

The use of the double balloon endoscope for ERCP in patients with surgically altered anatomy has shown to be safe and feasible. This technique permits a variety of diagnostic and therapeutic possibilities. A case is presented of a 38-year old male, admitted with jaundice, 8 months after surgery for a malignant liver tumour with construction of a Roux-en-Y hepaticojejunostomy. A stenosis at the site of the biliodigestive anastomosis was diagnosed. Combining double balloon endoscopy with a percutaneous approach in a rendezvous procedure, it was possible to place a self-expandable biliary metal stent. This is the first report of a successful placement of a metallic stent using this technique.