LAUSR

ENDOSCOPIC PAPILLARY BALLOON dilation (EPBD) is more commonly performed in balloon enteroscopy-assisted endoscopic retrograde cholangiopancreatography (BE-ERCP) than endoscopic sphincterotomy, where it can be difficult to point the sphincterotome blade in the appropriate direction. However, balloon slippage during inflation often occurs during the use of a forward-viewing endoscope in the absence of a forceps elevator. Slips can lead to multiple and otherwise unnecessary dilations and an increased risk of adverse events. While longer-length balloons can reduce slippage during BE-ERCP, it is often difficult to maintain a sufficient distance between the duodenal papilla and the tip of the scope. To address these problems, we developed a novel balloon catheter (RIGEL Balloon Dilatation Catheter; Japan Lifeline, Tokyo, Japan); it is 15-mm in length (Fig. 1), which is shorter than the 30– 50 mm range of currently available balloons. This balloon has an elastic band attached in the middle, and the central part expands with a delay, preventing slippage. An 84-yearold man who had undergone Billroth II gastrectomy developed obstructive jaundice from choledocholithiasis. A short-type single-BE was inserted up to the papilla, followed by biliary cannulation. Because the scope’s position was unstable and it frequently detached, we could not maintain a sufficient distance from the papilla. Thus, we inserted an 8-mm diameter novel balloon over the guidewire; the full length of the balloon could be projected from within the scope. The center of the novel balloon at the papilla extended with an appropriate delay during inflation, and full expansion until reaching 6 atm was obtained without slippage (Fig. 2 and Video S1). The stones were successfully removed with a retrieval basket catheter, with