The Importance of the Gel Immersion Method to Successfully Identify the Jejunojejunal Anastomosis Site After Roux-Y Reconstruction With Double-Balloon Enteroscopy-assisted Endoscopic Retrograde Cholangiopancreatography: A Case Report.

The gel immersion method improves endoscopic visualization by displacing debris and blood with a viscous gel. Although it is commonly used in procedures such as endoscopic mucosal resection and endoscopic submucosal dissection, its use in double-balloon enteroscopy-assisted endoscopic retrograde cholangiopancreatography (DBE-ERCP) has rarely been reported. An 81-year-old man with a history of distal gastrectomy and Roux-en-Y reconstruction underwent DBE-ERCP for recurrent common bile duct stones. Despite 98 min of conventional attempts, the jejunojejunal anastomosis could not be identified because visualization was impaired by postoperative adhesions and residual food debris. After switching to the gel immersion method, the anastomosis was clearly identified within 4 min. Stone removal was successfully performed, and the postoperative course was uneventful. In this case, the gel immersion method markedly improved visualization and reduced intraluminal pressure, thereby facilitating identification of the anastomosis. This method may be particularly useful when conventional visualization is difficult during DBE-ERCP, as it may enable rapid and safe identification of the jejunojejunal anastomosis.