Post written by Yuki Tanisaka, MD, PhD, from Saitama Medical University International Medical Center, Saitama, Japan.

Endoscopic stone extraction in patients with surgically altered anatomy (SAA) using balloon enteroscopy is considered difficult. Although endoscopic papillary balloon dilation (EPBD) is one of the necessary procedures to extract the stone, EPBD in patients with SAA is challenging because the EPBD catheter is prone to slipping in or out of the papilla during balloon inflation, making it time consuming and possibly increasing adverse events.

A new EPBD catheter (RIGEL; Japan Lifeline, Shinagawa, Japan) with a length and diameter of 220 cm and 2.37 mm, respectively, was developed. The balloon length is 20 mm, shorter than other available balloon catheters. It facilitates dilation of the papilla or anastomotic strictures, such as hepaticojejunal anastomosis, more selectively and does not increase the distance between the papilla and the scope during balloon inflation. The distal and proximal ends of the balloon inflate first, and then the middle inflates to prevent the catheter from slipping in or out of the papilla.

Moreover, a black elastic band is attached in the middle of the balloon to enhance confirming the center of the balloon endoscopically. We report a case of successful EPBD using this novel balloon dilation catheter in a patient with SAA.

A 77-year-old man who underwent distal gastrectomy with Roux-en-Y was referred to our hospital for treating choledocholithiasis. ERCP was performed using a short-type single-balloon enteroscopy (SIF-H290; Olympus Marketing, Shinjuku, Japan) with a working length of 152 cm and a working channel of 3.2 mm in diameter. Cholangiography revealed a small stone of approximately 5 mm in the common bile duct. The new EPBD catheter with a diameter of 8 mm was inserted. EPBD was performed effortlessly and effectively without slipping in or out of the papilla, and the orifice of the papilla was dilated.

As a result, the stone was extracted smoothly using a basket catheter. This novel balloon dilation catheter can help achieve effective EPBD without catheter slippage in or out of the papilla, facilitating stone extraction in patients with SAA, especially with a small stone, thus preserving the biliary sphincter function. It would be a good selection for stone extraction and aid in standardization of stone extraction in patients with SAA.

We wanted to show the usefulness of this novel catheter, which is helpful with the papilla and hepaticojejunal anastomosis. If this device is available internationally, it would be beneficial for treatment of patients with SAA.

As this EPBD catheter is so useful, we hope it will be available all over the world!

A, Balloon is inflated without slipping in or out of the papilla. B and C, Endoscopic papillary balloon dilation is performed effectively. D, The orifice of the papilla is dilated.

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