Successful Cholangioscopy-Guided Stone Extraction in a Choledocholithiasis Patient With Afferent Loop Stenosis After Pancreaticoduodenectomy.

Choledocholithiasis after pancreaticoduodenectomy is difficult to manage because surgically altered anatomy limits conventional endoscopic access. This difficulty is compounded when afferent loop stenosis is present. We report a 53-year-old man with a previous pancreaticoduodenectomy who presented with abdominal pain and fever. Imaging revealed common bile duct stones. During endoscopic retrograde cholangiopancreatography, severe afferent loop stenosis prevented duodenoscope advancement and guidewire cannulation. The peroral eyeMAX cholangioscope was then used; its slim profile allowed traversal of the stenosis, enabling direct visualization and balloon-assisted stone extraction. This case highlights peroral cholangioscopy as an effective rescue option in this difficult setting.