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 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'.)To continue reading this article, you must log in with your personal, hospital, or group practice subscription. For more information on subscription options, click below on the option that best describes you:
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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
- Transgastric approach
- - Laparoscopy-assisted ERCP
- Less common approaches
- SUMMARY AND RECOMMENDATIONS