PMC2821765_01
Rendezvous technique for acute angulation of Roux-en-Y limb. (a) X-ray film showed that a guidewire advanced over the Roux-en-Y limb. (b) Endoscopic imaging revealed that a guidewire reached the Roux-en-Y limb.
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fig1
A hydrophilic guidewire (Radifocus, Terumo, Tokyo, Japan) with an ERCP catheter was antegradely advanced beyond the Roux limb (Figures 1(a) and 1(b)). 
Enteroscope assisted ERCP. (a) X-ray film showed that an enteroscope reached the papilla using rendezvous technique. (b) Cholangiogram revealed bile duct stones.
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fig2
Then the enteroscope was inserted to the Roux limb after a guidewire was found and firmly grasped by a snare forceps, it was pulled out of the body through the working channel of the enteroscope resulting that the enteroscope could advance to the papilla (Figure 2(a)). Cholangiogram revealed bile duct stones (Figure 2(b)). 
Direct cholangioscopy for bile duct stones. (a) Endoscopic imaging showed bile duct stones. (b) Bile duct stones were completely removed.
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fig3
Direct endoscopic imaging revealed bile duct stones (Figure 3(a)). Finally, complete removal of bile duct stones was confirmed by direct endoscopic imaging (Figure 3(b)).