Usefulness of endoscopic nasobiliary drainage-guided ERCP in patients with surgically altered anatomy (with video)

Background and study aims  Endoscopic retrograde cholangiopancreatography (ERCP) in patients with surgically altered anatomy is one of the most challenging endoscopic procedures. Although single- or double-balloon endoscopes have been widely used, reaching the papilla of Vater (hepaticojejunostomy/pancreaticojejunostomy site) is often difficult. For patients in whom treatment cannot be completed in a single session, we placed endoscopic nasobiliary drainage (ENBD) at the end of the procedure; in the second session, the scope was inserted following ENBD placement. Patients and methods  Three patients with surgically altered anatomy and who underwent ENBD-guided ERCP were retrospectively examined using the medical records. Results  There were two men and one woman, with an average age of 75 years. The surgical procedure were distal gastrectomy and Roux-en-Y reconstruction in all patients. The diagnosis were choledocholithiasis in two and bile duct stricture in one. Average time to reach the papilla was 50 minutes (range, 21-102) for the first ERCP and was shortened to 11 minutes (range, 5-17) for the second session under an indwelling ENBD. Treatment was successful in all patients without complications. Conclusion  ENBD-guided ERCP in patients with surgically altered anatomy was a useful method that facilitated scope insertion and shortened the procedure time.