CASE REPORT : Open Access ; Single Balloon Enteroscopy-Assisted Endoscopic Retrograde Cholangiopancreatography in Patients Who Underwent a Gastrectomy with Roux-en-Y Anastomosis: Six Cases from a Single Center

• Published in: Clinical endoscopy 2015-09, Vol.48 (5), p.452
• Main Authors: Jae Seung Soh, Dong-hoon Yang, Sang Soo Lee, Seo Hyun Lee, Jung Ho Bae, Jeong-sik Byeon, Seung-jae Myung, Suk-kyun Yang
• Format: Article
• Language: Korean
• Subjects: Anastomosis; Cholangiopancreatography; endoscopic retrograde; Roux-en-Y; Single balloon enteroscopy
• ISSN: 2234-2400

Patients with altered anatomy such as a Roux-en-Y anastomosis often present with various pancreaticobiliary problems requiring therapeutic intervention. However, a conventional endoscopic approach to the papilla is very difficult owing to the long afferent limb and acute angle of a Roux-en-Y anastomosis. Balloon-assisted enteroscopy can be used for endoscopic retrograde cholangiopancreatography (ERCP) in patients with altered anatomy. We experienced six cases of Roux-en-Y anastomosis with biliary problems, and attempted ERCP using single balloon enteroscopy (SBE). SBE insertion followed by replacement with a conventional endoscope was attempted in five of six patients. The papilla was successfully approached using SBE in all cases. However, therapeutic intervention was completed in only three cases because of poor maneuverability caused by postoperative adhesion. We conclude that in patients with Roux-en-Y anastomosis, the ampulla can be readily accessed with SBE, but longer dedicated accessories are necessary to improve this therapeutic intervention. Clin Endosc 2015;48:452-457