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World J Surg Proced. Jul 28, 2014; 4(2): 23-32
Published online Jul 28, 2014. doi: 10.5412/wjsp.v4.i2.23
Endoscopic approaches to biliary intervention in patients with surgically altered gastroduodenal anatomy
Natalie D Cosgrove, Andrew Y Wang
Natalie D Cosgrove, Andrew Y Wang, Division of Gastroenterology and Hepatology, University of Virginia Health System, Charlottesville, VA 22908, United States
Author contributions: Cosgrove ND and Wang AY contributed equally to this manuscript.
Correspondence to: Andrew Y Wang, MD, FACG, FASGE, Associate Professor, Co-Medical Director of Endoscopy, Division of Gastroenterology and Hepatology, University of Virginia Health System, PO Box 800708, Charlottesville, VA 22908, United States.
Telephone: +1-434-9241653  Fax: +1-434-2447590
Received: November 11, 2013
Revised: January 1, 2014
Accepted: March 17, 2014
Published online: July 28, 2014
Core Tip

Core tip: In patients with short gastrojejunal “Roux” and bilio-pancreatic limbs, ideally less than 150 cm in length, starting with a (cap-assisted) push-enteroscopy or balloon-enteroscopy approach should offer reasonable diagnostic and therapeutic endoscopic retrograde cholangiopancreatography (ERCP) success. When available, short-single-balloon or short-double-balloon enteroscopes should be used, as they allow the use of conventional ERCP equipment, are associated with shorter procedure times, and are easier to manipulate. In patients with Roux-en-Y gastric bypass who have longer Roux and/or bilio-pancreatic limbs, or in patients who have failed prior attempts at deep enteroscopy-assisted ERCP, transgastric laparoscopy-assisted-ERCP should be considered, which is associated with high rates of diagnostic and therapeutic ERCP success.