Benign Biliary Strictures Treated with Fully Covered Metallic Stents in Patients with Surgically Altered Anatomy Using Double Balloon Enteroscopy

Introduction: Surgically altered anatomy complicates endoscopic procedures of the pancreaticobiliary tree. Biliary strictures have been managed using percutaneous transhepatic techniques. Materials and Methods: In recent years device-assisted enteroscopy (e.g., double balloon enteroscope [DBE]) has been used to gain access to the common bile duct. The length of the scope and its narrow, 2.8-mm working channel limit the use of standard endoscopic retrograde cholangiopancreatography (ERCP) devices. Therefore, shorter enteroscopes for ERCP have been developed. A fully covered self-expandable metallic stent (fcSEMS) cannot be used through the narrow channel. In conventional anatomy, benign biliary strictures have been treated using fcSEMS, requiring fewer endoscopies compared with multiple plastic stenting. Results: Here we report the first case of fcSEMS deployment through the working channel of a novel, long DBE with a 3.2-mm working channel, and 2 cases with the conventional narrow-channel DBE, using the rendezvous technique, with fcSEMS insertion on a wire running along the enteroscope. Conclusions: These new techniques, here used on benign biliary strictures, are described in detail.