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• W2022355079 abstract "ERCP in patients who have undergone GI surgery is difficult because of the anatomic changes in the digestive tract. Several case series have reported that successful cannulation was achieved by use of a front-viewing endoscope,1Matsushita M. Takakuwa H. Uchida K. et al.Techniques to facilitate ERCP with a conventional endoscope in patients with previous pancreatoduodenectomy.Endoscopy. 2009; 41: 902-906Crossref PubMed Scopus (14) Google Scholar a single-balloon enteroscope, or a double-balloon enteroscope.2Neumann H. Fry L.C. Meyer F. et al.Endoscopic retrograde cholangiopancreatography using the single balloon enteroscope technique in patients with Roux-en-Y anastomosis.Digestion. 2009; 80: 52-57Crossref PubMed Scopus (69) Google Scholar, 3Mönkemüller K. Fry L.C. Bellutti M. et al.ERCP with the double balloon enteroscope in patients with Roux-en-Y anastomosis.Surg Endosc. 2009; 23: 1961-1967Crossref PubMed Scopus (68) Google Scholar, 4Layec S. D'Halluin P.-N. Pagenault M. et al.Removal of transanastomotic pancreatic stent tubes after pancreaticoduodenectomy: a new role for double-balloon enteroscopy.Gastrointest Endosc. 2010; 72: 449-451Abstract Full Text Full Text PDF PubMed Scopus (16) Google Scholar, 5Cho S. Kamalaporn P. Kandel G. et al.‘Short’ double-balloon enteroscope endoscopic retrograde cholangiopancreatography in patients with a surgically altered upper gastrointestinal tract.Can J Gastroenterol. 2011; 25: 615-619Crossref PubMed Scopus (53) Google Scholar, 6Itoi T. Ishii K. Sofuni A. et al.Ultraslim endoscope-assisted therapeutic ERCP for inaccessible papilla by a double-balloon enteroscope in patients with Roux-en-Y anastomosis.Endoscopy. 2011; 43: E36-E37Crossref PubMed Scopus (7) Google Scholar, 7Moreels T.G. Pelckmans P.A. Comparison between double-balloon and single-balloon enteroscopy in therapeutic ERC after Roux-en-Y entero-enteric anastomosis.World J Gastrointest Endosc. 2010; 2: 314-317Crossref PubMed Google Scholar, 8Itoi T. Ishii K. Sofuni A. et al.Single-balloon enteroscopy–assisted ERCP in patients with Billroth II gastrectomy or Roux-en-Y anastomosis.Am J Gastroenterol. 2010; 105: 93-99Crossref PubMed Scopus (137) Google Scholar There are a few reported cases of using a conventional duodenoscope to perform cannulation in patients after GI surgery.9Nakahara K. Horaguchi J. Fujita N. et al.Therapeutic endoscopic retrograde cholangiopancreatography using an anterior oblique-viewing endoscope for bile duct stones in patients with prior Billroth II gastrectomy.J Gastroenterol. 2009; 44: 212-217Crossref PubMed Scopus (41) Google Scholar, 10Xue-feng W. Jia-wei M. Wen-jie Z. et al.Endoscopic retrograde cholangiopancreatography after Billroth II gastrectomy.Chin J Dig Endosc. 2010; 27: 451-453Google Scholar Here we present our experience with using a conventional duodenoscope in a patient who had a history of GI surgery. One of the major challenges is how to get the duodenoscope into the afferent loop. For example, usually the afferent loop is at the lesser curvature of the stomach in postpancreaticoduodenectomy patients; our maneuver was to extend the duodenoscope along the greater curvature of the stomach until we saw the gastrojejunal anastomosis in which the “upper tunnel” was the exact entrance of the right afferent loop (Fig. 1). Sometimes we could draw back the duodenoscope to “relax” the gastrojejunal anastomosis to differentiate the “upper entrance” from the “lower entrance.” In addition, we could also use a catheter (usually the wire-guided retrieval balloon) with contrast medium to explore the precise entrance of the afferent loop. It should be emphasized that the image we saw on balloon-assisted enterography was more helpful for ERCP in patients after GI surgery. It helps the endoscopist see the altered structure clearly and allows the endoscope to move more smoothly along the digestive duct and minimize accidental injury to the intestinal wall (Fig. 2). For jejunojejuno anastomosis, the retrieval balloon catheter can also be stationed in the afferent loop as a guide to keep the duodenoscope from sliding out of the right loop (Fig. 3).Fig. 2Exploring the afferent limb of postpancreaticoduodenectomy patient by retrieval balloon-assisted enterography using conventional duodenoscope.View Large Image Figure ViewerDownload Hi-res image Download (PPT)Fig. 3Jejunojejuno anastomosis: the retrieval balloon catheter can be stationed in the afferent loop (the middle cave in this view) as a guide to avoid the duodenoscope.View Large Image Figure ViewerDownload Hi-res image Download (PPT)" @default.
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• W2022355079 title "ERCP with retrieval balloon-assisted enterography using traditional duodenoscope in post-GI surgery patients" @default.
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