title: Endoscopic bile duct and/or pancreatic duct cannulation technique for patients with surgically altered gastrointestinal anatomy.
abstract: There are two major hurdles to carrying out endoscopic retrograde cholangiopancreatography (ERCP) in patients with altered gastrointestinal anatomy (Billroth II gastrectomy [B-II], Roux-en-Y anastomosis [R-Y] etc.), post-pancreatoduodenectomy or post-choledochojejunostomy. These are: (i) the endoscopic approach to the afferent loop, blind end, and the site of bilio-pancreatic anastomosis; and (ii) bile duct and/or pancreatic duct cannulation. Balloon-assisted enteroscopy (BAE) became available in recent years and is now being actively used to overcome the first hurdle and, at least, the success rate has improved. However, room for improvement still remains in regards to the second hurdle (i.e. the success rate of cannulation of the bile duct and/or pancreatic duct), and there has been a desire for the development of dedicated devices (ERCP catheters, hoods etc.) and for improvement in the functionality of the enteroscopes etc. In the present review, we explain the basic procedure for bile duct and/or pancreatic duct cannulation with conventional endoscopes and BAE, and modifications of the basic procedure.
authors.affiliation: Division of Gastroenterology, Department of Medicine, Kurume University School of Medicine, Kurume, Japan.
authors.forename: Yoshinobu
authors.initials: Y
authors.lastname: Okabe
authors.forename: Yusuke
authors.initials: Y
authors.lastname: Ishida
authors.forename: Kei
authors.initials: K
authors.lastname: Kuraoka
authors.forename: Tomoyuki
authors.initials: T
authors.lastname: Ushijima
authors.forename: Osamu
authors.initials: O
authors.lastname: Tsuruta
mesh_terms: D000713:Anastomosis, Roux-en-Y / Q000379:methods; D001652:Bile Ducts / Q000601:surgery*; D002404:Catheterization / Q000379:methods; D002760:Cholangiopancreatography, Endoscopic Retrograde / Q000009:adverse effects / Q000379:methods*; D002768:Choledochostomy / Q000379:methods; D016145:Endoscopy, Digestive System / Q000379:methods*; D005260:Female; D005500:Follow-Up Studies; D005743:Gastrectomy / Q000379:methods; D005763:Gastroenterostomy / Q000379:methods; D005767:Gastrointestinal Diseases / Q000601:surgery; D006801:Humans; D008297:Male; D019060:Minimally Invasive Surgical Procedures / Q000379:methods; D010183:Pancreatic Ducts / Q000601:surgery*; D016577:Pancreaticoduodenectomy / Q000379:methods; D058996:Quality Improvement; D012086:Reoperation / Q000379:methods; D018570:Risk Assessment; D016896:Treatment Outcome
keywords: ERCP catheter; altered gastrointestinal anatomy; balloon-assisted enteroscopy; cannulation; endoscopic retrograde cholangiopancreatography (ERCP)