title: Double balloon endoscopy for pancreatic and biliary access in altered anatomy (with videos).
abstract: BACKGROUND
  Access to the papilla of Vater or enteral anastomoses to the biliary tract or pancreatic duct is difficult in patients with altered anatomy. The usual approach to the papilla of Vater with a side-viewing duodenoscope, designed for passage through the stomach, pyloric channel, and proximal duodenum, is not suitable in postoperative patients with challenging anatomic rearrangements. There is therefore a need for better instrumentation to achieve access in patients with difficult anatomy.
  
  
  OBJECTIVE
  To assess the potential of the new double balloon endoscope system for use in difficult postsurgical anatomic configurations. This system has now been utilized in several of these types of anatomic rearrangements with successful access to the papilla of Vater and hepatico-jejunal, choledocho-jejunal, or pancreatico-jejunal anastomoses. The technique of advancing the system and achieving cannulation is described. The accessories necessary and therapeutic potential are addressed.
  
  
  METHODS
  Diagnostic and therapeutic management of pancreatic and biliary disorders in altered anatomy.
  
  
  CONCLUSIONS
  Double balloon enteroscopy has provided a means to access the stomach, duodenum, biliary tract, and pancreatic duct after surgical procedures that have made access by the usual routes with the usual instruments not possible.
authors: Division of Gastroenterology and Center for Advanced Therapeutic Endoscopy, Lenox Hill Hospital, New York, New York 10021, USA.
authors: Gregory B
authors: GB
authors: Haber
mesh_terms: D000713:Anastomosis, Roux-en-Y; D000714:Anastomosis, Surgical; D001660:Biliary Tract Diseases / Q000601:surgery*; D020776:Endoscopes, Gastrointestinal; D016099:Endoscopy, Gastrointestinal / Q000379:methods*; D004867:Equipment Design; D042882:Gallstones / Q000628:therapy; D005743:Gastrectomy; D006801:Humans; D007410:Intestinal Diseases / Q000175:diagnosis / Q000628:therapy*; D007415:Intestinal Obstruction / Q000175:diagnosis / Q000628:therapy; D007421:Intestine, Small; D007582:Jejunostomy; D011183:Postoperative Complications / Q000175:diagnosis / Q000628:therapy*; D016717:Sphincterotomy, Endoscopic / Q000295:instrumentation*; D013272:Stomach Diseases / Q000601:surgery*