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a short DBE (EI-B530; Fujifilm, Tokyo, Japan) was applied for ERCP by the same endoscopist. After reaching the papilla and carefully looking-up with the retroflex position, it was caught within a suitable distance. This manipulation adjusted the axis between the catheter and the bile duct, and resulted in successful WGC (Fig. 1c,d). Multiple bile duct stones were safely removed following endoscopic papillary large balloon dilation with endoscopic sphincterotomy. Compared with conventional methods, short DBE has superior flexibility, maneuverability, and stabilization with a small caliber, short tip bending in a small radius, and a balloon and overtube system; it also allows the use of most accessories (Fig. 2). Therefore, short DBE also has the advantage of easier access to the bile duct. Short DBE should be considered for biliary intervention in patients with Roux-en-Y gastrectomy, even if these procedures fail despite successful scope insertion using PC. The authors declare no conflicts of interest for this article.