Inclusion criteria  Signed informed consent Patients with surgically altered upper Gastrointestinal anatomy (Roux-en-Y and Billroth II types) with a biliary indication for ERCP where access with conventional ERCP devices is of no avail and after careful risk assessment.  Exclusion criteria In addition to be eligible for study enrollment a subject must not meet any of the exclusion criteria listed below.  Age under 18 years Female and of child-bearing age who is currently pregnant or planning to become pregnant within the study period Any contraindication to standard enteroscopy or ERCP (e.g. severe coagulopathy or known coagulation disorder; bowel obstruction / stenosis, stents or other instruments implanted in the intestinal tract, suspected GI perforation, esophageal or gastric varices, eosinophilic esophagitis) as judged by the investigator after careful individual risk assessment Concurrent participation in another competing clinical study Pancreatic indication for ERCP in patient with surgically altered anatomy