Endoscopic retrograde cholangiopancreatography (ERCP) in patients with surgically altered anatomy (SAA) is technically challenging, not only because of the difficulty in reaching the target site but also in performing subsequent therapeutic procedures. To overcome these challenges, balloon enteroscopy-assisted ERCP has been introduced into clinical practice and has been reported to be both effective and safe. Recently, short-type balloon enteroscopes, with a working length of approximately 150 cm and a 3.2-mm working channel, have been widely adopted, making procedures more efficient. These short-type scopes facilitate the use of larger accessories in various procedures, such as stone extraction or self-expandable metallic stent placement. In addition, several new technologies and devices have recently been introduced to help manage difficult cases. Despite these advancements, multiple technical hurdles remain before procedures can be successfully completed. It is important to identify the key factors that contribute to procedural difficulty in order to improve success rates. At the same time, endoscopists must remain aware of the potential for adverse events, such as perforation, which can occur due to adhesions specific to SAA. In this review, we provide technical tips for short-type single-balloon enteroscopy-assisted ERCP in patients with SAA, aimed at improving procedural success rates and reducing adverse events, while also highlighting recent advancements in technology and devices.

INTRODUCTION
TIPS FOR SCOPE INSERTION
TIPS FOR SELECTIVE BILIARY CANNULATION
TIPS FOR SUBSEQUENT PROCEDURES
RECENT ADVANCEMENTS IN TECHNOLOGYAND DEVICES
CONCLUSION
ORCID
AUTHOR CONTRIBUTIONS
REFERENCES

• Yuki Tanisaka(Department of Gastroenterology, Saitama Medical University International Medical Center, Saitama, Japan) Corresponding author
• Shomei Ryozawa(Department of Gastroenterology, Saitama Medical University International Medical Center, Saitama, Japan)
• Masafumi Mizuide(Department of Gastroenterology, Saitama Medical University International Medical Center, Saitama, Japan)
• Akashi Fujita(Department of Gastroenterology, Saitama Medical University International Medical Center, Saitama, Japan)
• Ryuichi Watanabe(Department of Gastroenterology, Saitama Medical University International Medical Center, Saitama, Japan)
• Ryosuke Hamamura(Department of Gastroenterology, Saitama Medical University International Medical Center, Saitama, Japan)