Endoscopic retrograde cholangiopancreatography in the surgically modified gastrointestinal tract

Endoscopic retrograde cholangiopancreatography (ERCP) in the patient with altered intestinal anatomy secondary to surgery presents significant challenges to the endoscopist. Navigating anastamoses, cannulation using a forward viewing endoscope in a retrograde position and use of specialized instruments encompass just a few of the unique issues which arise when attempting ERCP in patients with surgically altered anatomy. This article focuses on instruments, technique and a review of the published literature to date on performing ERCP in this group of patients.