A 79-year-old woman who had total gastrectomy, with R-Y for gastric cancer, was admitted for the treatment of bile duct stones. Although we tried SBE-assisted ERCP (XSIF-Q260Y; Olympus Medical Systems, Tokyo, Japan), an enteroscope could not be advanced to sharply angulated R-Y limb. Three days later, we performed rendezvous technique-assisted SBE using carbon dioxide during the procedure. At first, a guidewire was passed antegradely through the major papilla after the needle puncture using a percutaneous transhepatic biliary drainage (PTBD) technique. A hydrophilic guidewire (Radifocus, Terumo, Tokyo, Japan) with an ERCP catheter was antegradely advanced beyond the Roux limb (Figures 1(a) and 1(b)). 
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)). 
After papillary dilation using a 15-mm large-balloon (CRE Esophageal/Pyloric, length 5 cm, Boston Scientific Japan, Tokyo, Japan) without sphincterotomy because the major papilla was not well positioned for the sphincterotomy, an enteroscope as a direct cholangioscope was advanced into the bile duct. Direct endoscopic imaging revealed bile duct stones (Figure 3(a)). Bile duct stones were removed using a basket catheter and retrieval balloon. Finally, complete removal of bile duct stones was confirmed by direct endoscopic imaging (Figure 3(b)). Then, a guidewire was pulled out through the working channel. There was no procedure-related complication.