[Endoscopic-retrograde cholangiopancreatography in patients with surgical modification of anatomy]

Endoscopic retrograde cholangiopancreatography (ERCP) is an essential element in treating disease of the bilio-pancreatic system. In some patients, access to the bile ducts is limited due to operatively altered anatomy. The aim of this review is to illustrate the endoscopic procedure in these patients. We present the available evidence and comment on our approach to ERCP in patients with surgical modification of anatomy. In conclusion, conventional side-viewing or forward-viewing endoscopes allow one to access the biliary system in most patients with Billroth-II or partial pancreaticoduodenectomy. By use of balloon enteroscopy, biliary intervention in spite of surgical reconstruction with a long limb - such as Roux-en-Y gastrojejunostomy or hepaticojejunostomy and gastric bypass for obesity - has become feasible in many cases. Adaption of accessory devices to balloon-assisted enteroscopes permits therapeutic interventions in these patients.