title: Rotational assisted endoscopic retrograde cholangiopancreatography in patients with reconstructive gastrointestinal surgical anatomy.
abstract: OBJECTIVE
  To evaluate the success rates of performing therapy utilizing a rotational assisted enteroscopy device in endoscopic retrograde cholangiopancreatography (ERCP) in surgically altered anatomy patients.
  
  
  METHODS
  Between June 1, 2009 and November 8, 2012, we performed 42 ERCPs with the use of rotational enteroscopy for patients with altered anatomy (39 with gastric bypass Roux-en-Y, 2 with Billroth II gastrectomy, and 1 with hepaticojejunostomy associated with liver transplant). The indications for ERCP were: choledocholithiasis: 13 of 42 (30.9%), biliary obstruction suggested on imaging: 20 of 42 (47.6%), suspected sphincter of Oddi dysfunction: 4 of 42 (9.5%), abnormal liver enzymes: 1 of 42 (2.4%), ascending cholangitis: 2 of 42 (4.8%), and bile leak: 2 of 42 (4.8%). All procedures were completed with the Olympus SIF-Q180 enteroscope and the Endo-Ease Discovery SB overtube produced by Spirus Medical.
  
  
  RESULTS
  Successful visualization of the major ampulla was accomplished in 32 of 42 procedures (76.2%). Cannulation of the bile duct was successful in 26 of 32 procedures reaching the major ampulla (81.3%). Successful therapeutic intervention was completed in 24 of 26 procedures in which the bile duct was cannulated (92.3%). The overall intention to treat success rate was 64.3%. In terms of cannulation success, the intention to treat success rate was 61.5%. Ten out of forty two patients (23.8%) required admission to the hospital after procedure for abdominal pain and nausea, and 3 of those 10 patients (7.1%) had a diagnosis of post-ERCP pancreatitis. The average hospital stay was 3 d.
  
  
  CONCLUSIONS
  It is reasonable to consider an attempt at rotational assisted ERCP prior to a surgical intervention to alleviate biliary complications in patients with altered surgical anatomy.
authors: Majed El Zouhairi, James B Watson, Svetang V Desai, David K Swartz, Mahfuzul Haque, Paul S Jowell, Malcolm S Branch, Rebecca A Burbridge, Division of Gastroenterology, Duke University Medical Center, Durham, NC 27710, United States.
authors: Majed El
authors: ME
authors: Zouhairi
authors: Majed El Zouhairi, James B Watson, Svetang V Desai, David K Swartz, Mahfuzul Haque, Paul S Jowell, Malcolm S Branch, Rebecca A Burbridge, Division of Gastroenterology, Duke University Medical Center, Durham, NC 27710, United States.
authors: James B
authors: JB
authors: Watson
authors: Majed El Zouhairi, James B Watson, Svetang V Desai, David K Swartz, Mahfuzul Haque, Paul S Jowell, Malcolm S Branch, Rebecca A Burbridge, Division of Gastroenterology, Duke University Medical Center, Durham, NC 27710, United States.
authors: Svetang V
authors: SV
authors: Desai
authors: Majed El Zouhairi, James B Watson, Svetang V Desai, David K Swartz, Mahfuzul Haque, Paul S Jowell, Malcolm S Branch, Rebecca A Burbridge, Division of Gastroenterology, Duke University Medical Center, Durham, NC 27710, United States.
authors: David K
authors: DK
authors: Swartz
authors: Majed El Zouhairi, James B Watson, Svetang V Desai, David K Swartz, Mahfuzul Haque, Paul S Jowell, Malcolm S Branch, Rebecca A Burbridge, Division of Gastroenterology, Duke University Medical Center, Durham, NC 27710, United States.
authors: Alejandra
authors: A
authors: Castillo-Roth
authors: Majed El Zouhairi, James B Watson, Svetang V Desai, David K Swartz, Mahfuzul Haque, Paul S Jowell, Malcolm S Branch, Rebecca A Burbridge, Division of Gastroenterology, Duke University Medical Center, Durham, NC 27710, United States.
authors: Mahfuzul
authors: M
authors: Haque
authors: Majed El Zouhairi, James B Watson, Svetang V Desai, David K Swartz, Mahfuzul Haque, Paul S Jowell, Malcolm S Branch, Rebecca A Burbridge, Division of Gastroenterology, Duke University Medical Center, Durham, NC 27710, United States.
authors: Paul S
authors: PS
authors: Jowell
authors: Majed El Zouhairi, James B Watson, Svetang V Desai, David K Swartz, Mahfuzul Haque, Paul S Jowell, Malcolm S Branch, Rebecca A Burbridge, Division of Gastroenterology, Duke University Medical Center, Durham, NC 27710, United States.
authors: Malcolm S
authors: MS
authors: Branch
authors: Majed El Zouhairi, James B Watson, Svetang V Desai, David K Swartz, Mahfuzul Haque, Paul S Jowell, Malcolm S Branch, Rebecca A Burbridge, Division of Gastroenterology, Duke University Medical Center, Durham, NC 27710, United States.
authors: Rebecca A
authors: RA
authors: Burbridge
keywords: Ampulla of vater; Cholangiopancreatography; Double-Balloon enteroscopy; Endoscopic; Endoscopic retrograde; Gastric bypass; Gastrostomy; Pancreatitis; Retrospective studies; Sphincterotomy