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Related Concept Videos

Endoscopic Procedures V: ERCP01:26

Endoscopic Procedures V: ERCP

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Endoscopic Retrograde Cholangiopancreatography (ERCP) is a diagnostic procedure that combines endoscopy and fluoroscopy to diagnose and treat conditions related to the bile ducts, pancreatic ducts, and gallbladder. This procedure is beneficial for identifying and addressing blockages, gallstones, strictures, and tumors within the biliary or pancreatic systems. ERCP is both diagnostic and therapeutic, offering the ability to visualize and treat identified problems in one session.
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Endoscopic Procedures IV: Sigmoidoscopy and Laproscopy01:26

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Sigmoidoscopy and laparoscopy are distinct medical procedures that enable physicians to internally inspect different parts of the GI tract. Although they serve different purposes, each is essential for diagnosing and, in some cases, treating various medical conditions.
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Endoscopic Procedures I: Esophagogastroduodenoscopy01:29

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An Esophagogastroduodenoscopy (EGD) is a diagnostic procedure in which an endoscopist uses a flexible, lighted endoscope to visualize the upper gastrointestinal (GI) tract. The procedure includes visualizing the oropharynx, esophagus, stomach, and the first part of the small intestine, the duodenum.
During an EGD, the endoscope can be used to:
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Ultrasound II: Endoscopic Ultrasound and FibroScan01:25

Ultrasound II: Endoscopic Ultrasound and FibroScan

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Endoscopic Ultrasound (EUS) and FibroScan are valuable diagnostic tools in gastroenterology and hepatology, each with specific applications and techniques.
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Endoscopic Procedures II: Colonoscopy01:25

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The colon, or large intestine, is the final segment of the digestive system. Its primary functions include absorbing water and vitamins produced by gut bacteria and transforming waste from liquid to solid to form stool. In adults, the large intestine is approximately 5 feet long and consists of four main sections:
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Endoscopic Procedures III: Video Capsule Endoscopy01:28

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Capsule endoscopy, or wireless or video capsule endoscopy, is a diagnostic procedure for examining the entire gastrointestinal tract. Patients swallow a capsule about the size of a vitamin tablet. The capsule is equipped with a transmitter, a battery, an LED light source, and a color video camera to capture images throughout the gastrointestinal tract. This procedure is particularly useful for diagnosing conditions such as Crohn's disease, ulcerative colitis, tumors, polyps, ulcers,...
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Updated: Sep 8, 2025

Endoscopic Ultrasound-Guided Biliary Drainage: Endoscopic Ultrasound-Guided Hepaticogastrostomy in Malignant Biliary Obstruction
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Biliary Endoscopy in Altered Anatomy.

Linda Y Zhang1, Shayan Irani2, Mouen A Khashab1

  • 1Department of Gastroenterology & Hepatology, Johns Hopkins Medical Institutions, Baltimore, MD, USA.

Gastrointestinal Endoscopy Clinics of North America
|June 12, 2022
PubMed
Summary
This summary is machine-generated.

Endoscopic retrograde cholangiopancreatography (ERCP) offers high success for biliary disease in standard anatomy. This review details techniques for ERCP in patients with altered upper gastrointestinal anatomy, particularly Roux-en-Y reconstructions.

Keywords:
Altered anatomy ERCPEUS-Directed trans-gastric ERCPEnteroscopy-assisted ERCPGastrectomyLaparoscopy-assisted ERCPRoux-en-y gastric bypassWhipple surgery

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Area of Science:

  • Gastroenterology
  • Endoscopic Surgery

Background:

  • Endoscopic retrograde cholangiopancreatography (ERCP) is a primary treatment for biliary diseases, achieving over 90% success in patients with standard anatomy.
  • Anatomical variations in the upper gastrointestinal tract can present significant challenges for endoscopic biliary interventions.
  • Recent advancements have improved endoscopic management strategies for patients with altered gastrointestinal anatomy.

Purpose of the Study:

  • To provide practical tips and techniques for achieving successful biliary access in patients with common surgical alterations.
  • To focus on the management of biliary diseases specifically in patients who have undergone Roux-en-Y (RY) reconstructions.

Main Methods:

  • This is a review article synthesizing current knowledge and techniques.
  • Focuses on common upper gastrointestinal surgical alterations impacting ERCP.
  • Highlights strategies for biliary access and disease management in RY patients.

Main Results:

  • Standard ERCP techniques may be insufficient in patients with altered anatomy.
  • Specific modifications and approaches are necessary for successful biliary access in these cases.
  • Management strategies for biliary diseases in RY patients can be effectively adapted for endoscopic intervention.

Conclusions:

  • Successful ERCP in patients with altered anatomy is achievable with specialized techniques.
  • This review offers valuable guidance for endoscopists managing complex biliary cases.
  • Focusing on RY reconstructions provides targeted insights for a common post-surgical alteration.