ERCP in patients with Roux-en-Y anatomy
- Christopher S Huang, MD
Christopher S Huang, MD
- Assistant Professor of Medicine
- Boston University School of Medicine
Performing endoscopic retrograde cholangiopancreatography (ERCP) in patients with Roux-en-Y anatomy poses a major challenge to gastrointestinal endoscopists. In the current era of the obesity epidemic, this situation is encountered with increasing frequency due to the popularity of Roux-en-Y gastric bypass (RYGB) surgery (figure 1) and the high prevalence of gallstone disease in these patients [1-3]. (See "Bariatric procedures for the management of severe obesity: Descriptions", section on 'Roux-en-Y gastric bypass'.)
Roux-en-Y anatomy may also result from:
●Gastric resection surgery (figure 2 and figure 3). (See "Partial gastrectomy and gastrointestinal reconstruction" and "Total gastrectomy and gastrointestinal reconstruction".)
●Pancreaticoduodenectomy (figure 4 and figure 5 and figure 6). (See "Surgical resection of lesions of the head of the pancreas" and "Surgical resection of lesions of the body and tail of the pancreas".)
●Liver transplantation. (See "Living donor liver transplantation", section on 'Surgical techniques and recipient outcomes'.)
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- GENERAL CONSIDERATIONS
- Choosing the best approach
- - Native papilla
- - Bilioenteric or pancreatoenteric anastomosis
- TRANSORAL APPROACHES
- ERCP using standard duodenoscope
- ERCP using an enteroscope or pediatric colonoscope
- ERCP using deep enteroscopy techniques
- - Double balloon enteroscope-assisted ERCP
- - Single balloon enteroscope-assisted ERCP
- - Spiral enteroscopy-assisted ERCP
- SURGICAL APPROACHES
- ERCP through a gastrostomy or jejunostomy tract
- Laparoscopy-assisted ERCP
- SUMMARY AND RECOMMENDATIONS