EUS-guided antegrade pancreatic guidewire placement for double-guidewire technique in single-balloon enteroscope-assisted ERCP

An 81-year-old man with distal gastrectomy and Roux-en-Y reconstruction for gastric cancer presented with obstructive jaundice caused by cancer recurrence. Percutaneous transhepatic biliary drainage was not attempted because the patient did not consent to external drainage tube placement, even if it was temporary. Biliary or pancreatic cannulation was impossible with endoscopic retrograde cholangiopancreatography (ERCP) using a short-type single-balloon enteroscope (SBE, SIF-H290S; Olympus Medical Systems, Tokyo, Japan) because cancer had invaded the papilla.