title: Large dilating balloon to allow endoscope insertion for successful endoscopic retrograde cholangiopancreatography in patients with surgically altered anatomy (with video).
abstract: OBJECTIVE
  Endoscopic retrograde cholangiopancreatography (ERCP) in patients with surgically altered anatomy can be present unique challenges. One of the major obstacles preventing successful ERCP is acute angulation and long afferent loops in patients with Billroth II gastrectomy or Roux-en-Y anastomosis. Here, we described a novel technique for successful endoscope insertion using a large dilating balloon.
  
  
  METHODS
  The large dilating balloon (maximum diameter 20 mm) is used as an anchor for endoscope insertion (hooking method) in patients with Billroth II gastrectomy in whom no other endoscopes could be advanced into the end of the duodenum or the Roux-en-Y anastomosis.
  
  
  RESULTS
  The hooking method allows the endoscope to be advanced into the proximal afferent loop, even in patients with sharp angulation of the Y limb.
  
  
  CONCLUSIONS
  To the best of our knowledge, this is the first report on the use of a large dilating balloon for endoscope insertion in patients with surgically altered anatomy, in particular Roux-en-Y anastomosis. We believe this technique may be effective for difficult cases like the present case.
authors.affiliation: Department of Gastroenterology and Hepatology, Tokyo Medical University, Tokyo, Japan. itoi@tokyo-med.ac.jp
authors.forename: Takao
authors.initials: T
authors.lastname: Itoi
authors.forename: Atsushi
authors.initials: A
authors.lastname: Sofuni
authors.forename: Fumihide
authors.initials: F
authors.lastname: Itokawa
mesh_terms: D000369:Aged, 80 and over; D000713:Anastomosis, Roux-en-Y / Q000009:adverse effects; D002404:Catheterization / Q000295:instrumentation*; D002760:Cholangiopancreatography, Endoscopic Retrograde / Q000379:methods*; D002761:Cholangitis / Q000175:diagnosis* / Q000601:surgery; D003937:Diagnosis, Differential; D019723:Endoscopes; D004867:Equipment Design; D005260:Female; D005743:Gastrectomy / Q000009:adverse effects* / Q000379:methods; D006801:Humans; D008875:Middle Aged; D013276:Stomach Ulcer / Q000601:surgery*; D014741:Video Recording