title: Double-balloon ERCP in patients who have undergone Roux-en-Y surgery: a case series.
abstract: BACKGROUND
  ERCP is technically challenging in patients who have had a long-limb Roux-en-Y surgical procedure. The recent introduction of the double-balloon endoscope permits the examination of a much longer segment of the small bowel compared with a standard endoscope and may be used to perform ERCP in these patients.
  
  
  OBJECTIVE
  To report successful use of double-balloon ERCP in patients who have had a Roux-en-Y surgical procedure.
  
  
  METHODS
  Fourteen patients with a history of either Roux-en-Y gastric bypass weight-reduction surgery or Roux-en-Y pancreatobiliary surgery required diagnostic and/or therapeutic pancreatobiliary intervention.
  
  
  METHODS
  Case report.
  
  
  METHODS
  Double-balloon ERCP.
  
  
  RESULTS
  Fourteen patients underwent a total of 20 ERCPs with the double-balloon endoscopy system. The ampulla was successfully reached in 85% of total cases (100% of patients who have had Roux-en-Y weight reduction surgery), with adequate cannulation of either the biliary or pancreatic duct in 80% (88% of patients for weight reduction). Therapeutic intervention, including stone removal, pancreatobiliary-duct dilation, sphincterotomy, stent placement, and removal of previously placed stents, was performed successfully in 6 cases. The mean age was 47 years old. The mean (+/- standard deviation) total duration of the procedure was 99 +/- 48 minutes. There were no immediate or short-term complications.
  
  
  CONCLUSIONS
  The double-balloon endoscopy system permits diagnostic and therapeutic ERCP in patients who have had long-limb surgical procedures. Our experience demonstrated that this procedure is well tolerated, safe, and has a high success rate.
authors.affiliation: Department of Gastroenterology, Baylor University Medical Center, Dallas, TX 75246, USA.
authors.forename: Daniel S
authors.initials: DS
authors.lastname: Emmett
authors.forename: Damien B
authors.initials: DB
authors.lastname: Mallat
mesh_terms: D000328:Adult; D000368:Aged; D014670:Ampulla of Vater; D002404:Catheterization; D002760:Cholangiopancreatography, Endoscopic Retrograde / Q000592:standards*; D003938:Diagnostic Techniques, Digestive System / Q000592:standards; D013505:Digestive System Surgical Procedures / Q000592:standards; D019723:Endoscopes; D016145:Endoscopy, Digestive System; D005260:Female; D015390:Gastric Bypass; D006801:Humans; D008297:Male; D008875:Middle Aged; D016896:Treatment Outcome