Endoscopic retrograde cholangiopancreatography in patients with roux-en-Y anatomy

Bleeding after Percutaneous Transhepatic Biliary Drainage: Incidence, Causes and Treatments

“…However, the common bile duct (CBD) cannot be cannulated endoscopically in approximately 8% of all attempted cases [ 4 ]. Additionally, when the anatomy of the upper gastrointestinal (GI) tract is surgically altered, such as after Roux-en-Y gastric bypass for obesity, Billroth II for gastric cancer or peptic ulcer disease and Roux-en-Y hepaticojejunostomy for liver transplantation, it is not possible to access the biliary system using traditional endoscopy techniques [ 5 , 6 , 7 ]. Percutaneous transhepatic biliary drainage (PTBD) is therefore the procedure of choice for these patients as well as for those in whom endoscopic cannulation of the CBD has failed and for those patients who have persistent obstruction or leak despite endoscopic therapy [ 8 ].…”

Endoscopic Management of Bariatric Surgery Complications

“…The largest multicenter study to date comparing DBE, SBE, and spiral enteroscopy (SE) evaluated 129 patients of whom 62 had RYGB and 45 had hepaticojejunostomy. 123,124 The ampulla was reached in 74%, 69%, and 72%, whereas ERCP was successful in 63%, 60%, and 65% in DBE, SBE, and SE, respectively. Collectively, of those procedures that achieved cannulation, 88% had successful ERCP.…”

“…123 Bertin et al 125 reported a pancreatic duct cannulation rate of 89% and bile duct cannulation rate of 94% in 22 cases. In the largest series to date studying this population, Schreiner and colleagues compared 24 patients who underwent LA-ERCP and 32 patients who underwent BEA-ERCP and found that LA-ERCP was superior to BEA-ERCP in papilla identification, cannulation rate, and therapeutic success.…”

“…However, it is a more invasive technique that typically requires 2 separate procedures with maturation of the PEG tract. 123 Saxena and colleagues used SBE to access the excluded stomach in a patient with choledocholithiasis and identified a PEG site via transillumination followed by gastrostomy tube insertion over a wire through the overtube. Subsequent successful ERCP before gastrostomy maturation was achieved using a SEMS to avoid perforation and a high-pressure burst balloon dilator.…”

Review article including treatment algorithm: endoscopic treatment of luminal complications after bariatric surgery

“…Yet, cholecystolithiasis and choledocholithiasis are frequently encountered conditions in patients after bariatric surgery . The major duodenal papilla is then only reached in three fourths of the time by overtube‐assisted enteroscopy, and endoscopic retrograde cholangiopancreatography (ERCP) is only successful in approximately 60% of patients . The gastric remnant is reached in only about 50%.…”