LAUSR

The usefulness of therapeutic modalities using double-balloon endoscopy for biliary disease in postoperative patients has been widely reported [1–3], while papers published about its use in pancreatic disease are scarce, despite an increasing demand for such treatment. This is the first report of successful double-balloon endoscopy-assisted endoscopic retrograde pancreatography (DB-ERP) using a clear long cap for a pinhole-like benign stricture in the pancreaticojejunal anastomosis after pancreaticoduodenectomy. A 63-year-old woman who had undergone pancreaticoduodenectomy for a lower bile duct cyst with abnormal confluence suffered recurrent pancreatitis 1 year after surgery. Obstructive pancreatitis due to stenosis in the pancreaticojejunal anastomosis was suspected on imaging (▶Fig. 1). The main pancreatic duct (PD) was mildly dilated, which posed a risk for intervention by endoscopic ultrasound (EUS), so we decided to perform DB-ERP instead. A clear long cap (▶Fig. 2) was attached in an attempt to make any endoscopic maneuvers smoother. The expected advantages of this were: to allow it to be pressed against the intestinal wall, so that even sutures covered by mucosa could be easily detected; to allow the pancreaticojejunal anastomosis to be shown in the vertical direction, instead of the normal tangential direction; to allow a certain distance to be maintained between the endoscope and the pancreaticojejunal anastomosis, which would enable smooth endoscopic procedures and blindmaneuvers to be avoided. First, the pancreaticojejunal anastomosis was identified by fluoroscopic image, and the sutures fixing the pancreas and jejunum were then detected endoscopically (▶Fig. 3 a). By careful observation in the area of the sutures, the scar-like E-Videos