regarding our recent article ( 2 ), and were extremely interested to hear of their experience with a “ short ” double-balloon enteroscope (s-DBE) in patients with surgically altered anatomy who required endoscopic retrograde cholangiopancreatography (ERCP). Th eir comments include two essential themes, fi rst, that a single balloon or short scope is suffi cient to reach the papilla or pancreatobiliary anastomosis in surgically altered anatomy patients with a long aff erent loop, and second, that the DBE is advantageous in cases with sharp angulations of the small intestine, because the balloon on the tip of the DBE scope can pass such angulations better than the hook approach of the single-balloon enteroscope (SBE) scope ( 3 ). However, some endoscopists have suggested that the DBE set-up, and the management of two balloons are time-consuming or cumbersome compared with the SBE ( 3,4 ). Until now, we have used SBEs in 34 cases, and “ long ” DBE (l-DBE) and s-DBE in 13 and 8 cases, respectively. In our experience, the SBE is suffi cient to reach the papilla or pancreatobiliary anastomosis or to perform ERCP in all Roux-en-Y patients with a long aff erent loop. Although several investigators have studied this theme ( 5 ), it should be resolved by a prospective study in the near future. We prefer long-type enteroscopes including the SBE and l-DBE, because they enable reaching the papilla or anastomotic site with certainty, even in patients with long aff erent loops. In fact, we previously encountered two diffi cult cases in which the s-DBE could not reach the papilla because of a lack in length of the scope, but the SBE and l-DBE enteroscope reached the papilla in each of these cases, where severe adhesion of the intestine was seen in both. Although an s-DBE can reach the papilla or pancreatobiliary anastomosis using careful scope maneuvering to pass the loop formation of the intestine, it can be risky because of the possibility of serious adverse events such as perforation of the gastrointestinal tract, particularly in patients with severe adhesion of the intestine. Th us, we use the SBE for ERCP in patients with surgically altered anatomy as we think the longer scope can do everything the shorter scope can. However, when we use long-type scopes, we need long accessories. To date, long accessories are limited (6,7), although they are increasingly available in Japan. We hope to be able to use long accessories for ERCP in the near future.