title: Innovations and techniques for balloon-enteroscope-assisted endoscopic retrograde cholangiopancreatography in patients with altered gastrointestinal anatomy.
abstract: Endoscopic retrograde cholangiopancreatography (ERCP) remains challenging in patients who have undergone surgical reconstruction of the intestine. Recently, many studies have reported that balloon-enteroscope-assisted ERCP (BEA-ERCP) is a safe and effective procedure. However, further improvements in outcomes and the development of simplified procedures are required. Percutaneous treatment, Laparoscopy-assisted ERCP, endoscopic ultrasound-guided anterograde intervention, and open surgery are effective treatments. However, treatment should be noninvasive, effective, and safe. We believe that these procedures should be performed only in difficult-to-treat patients because of many potential complications. BEA-ERCP still requires high expertise-level techniques and is far from a routinely performed procedure. Various techniques have been proposed to facilitate scope insertion (insertion with percutaneous transhepatic biliary drainage (PTBD) rendezvous technique, Short type single-balloon enteroscopes with passive bending section, Intraluminal injection of indigo carmine, CO2 inflation guidance), cannulation (PTBD or percutaneous transgallbladder drainage rendezvous technique, Dilation using screw drill, Rendezvous technique combining DBE with a cholangioscope, endoscopic ultrasound-guided rendezvous technique), and treatment (overtube-assisted technique, Short type balloon enteroscopes) during BEA-ERCP. The use of these techniques may allow treatment to be performed by BEA-ERCP in many patients. A standard procedure for ERCP yet to be established for patients with a reconstructed intestine. At present, BEA-ERCP is considered the safest and most effective procedure and is therefore likely to be recommended as first-line treatment. In this article, we discuss the current status of BEA-ERCP in patients with surgically altered gastrointestinal anatomy.
authors.affiliation: Hiroshi Yamauchi, Mitsuhiro Kida, Hiroshi Imaizumi, Kosuke Okuwaki, Shiro Miyazawa, Tomohisa Iwai, Wasaburo Koizumi, Department of Gastroenterology, Kitasato University Hospital, Sagamihara, Kanagawa 252-0375, Japan.
authors.forename: Hiroshi
authors.initials: H
authors.lastname: Yamauchi
authors.affiliation: Hiroshi Yamauchi, Mitsuhiro Kida, Hiroshi Imaizumi, Kosuke Okuwaki, Shiro Miyazawa, Tomohisa Iwai, Wasaburo Koizumi, Department of Gastroenterology, Kitasato University Hospital, Sagamihara, Kanagawa 252-0375, Japan.
authors.forename: Mitsuhiro
authors.initials: M
authors.lastname: Kida
authors.affiliation: Hiroshi Yamauchi, Mitsuhiro Kida, Hiroshi Imaizumi, Kosuke Okuwaki, Shiro Miyazawa, Tomohisa Iwai, Wasaburo Koizumi, Department of Gastroenterology, Kitasato University Hospital, Sagamihara, Kanagawa 252-0375, Japan.
authors.forename: Hiroshi
authors.initials: H
authors.lastname: Imaizumi
authors.affiliation: Hiroshi Yamauchi, Mitsuhiro Kida, Hiroshi Imaizumi, Kosuke Okuwaki, Shiro Miyazawa, Tomohisa Iwai, Wasaburo Koizumi, Department of Gastroenterology, Kitasato University Hospital, Sagamihara, Kanagawa 252-0375, Japan.
authors.forename: Kosuke
authors.initials: K
authors.lastname: Okuwaki
authors.affiliation: Hiroshi Yamauchi, Mitsuhiro Kida, Hiroshi Imaizumi, Kosuke Okuwaki, Shiro Miyazawa, Tomohisa Iwai, Wasaburo Koizumi, Department of Gastroenterology, Kitasato University Hospital, Sagamihara, Kanagawa 252-0375, Japan.
authors.forename: Shiro
authors.initials: S
authors.lastname: Miyazawa
authors.affiliation: Hiroshi Yamauchi, Mitsuhiro Kida, Hiroshi Imaizumi, Kosuke Okuwaki, Shiro Miyazawa, Tomohisa Iwai, Wasaburo Koizumi, Department of Gastroenterology, Kitasato University Hospital, Sagamihara, Kanagawa 252-0375, Japan.
authors.forename: Tomohisa
authors.initials: T
authors.lastname: Iwai
authors.affiliation: Hiroshi Yamauchi, Mitsuhiro Kida, Hiroshi Imaizumi, Kosuke Okuwaki, Shiro Miyazawa, Tomohisa Iwai, Wasaburo Koizumi, Department of Gastroenterology, Kitasato University Hospital, Sagamihara, Kanagawa 252-0375, Japan.
authors.forename: Wasaburo
authors.initials: W
authors.lastname: Koizumi
mesh_terms: D001660:Biliary Tract Diseases / Q000175:diagnosis / Q000601:surgery*; D002760:Cholangiopancreatography, Endoscopic Retrograde / Q000009:adverse effects / Q000295:instrumentation* / Q000379:methods; D019723:Endoscopes; D004867:Equipment Design; D006801:Humans; D007422:Intestines / Q000601:surgery*; D010535:Laparoscopy; D010182:Pancreatic Diseases / Q000175:diagnosis / Q000601:surgery*; D018579:Patient Selection; D019651:Plastic Surgery Procedures / Q000009:adverse effects; D018570:Risk Assessment; D012307:Risk Factors; D016896:Treatment Outcome
keywords: Altered gastrointestinal anatomy; Balloon enteroscopy; Balloon-enteroscope-assisted endoscopic retrograde cholangiopancreatography; Endoscopic retrograde cholangiopancreatography