Endoscopic Management of Pancreatobiliary Diseases in Patients with Surgically Altered Anatomy: A Perspective from...

Endoscopic retrograde cholangiopancreatography (ERCP) has long been established as a standard procedure with a high success rate and an acceptable incidence of adverse events. However, performing ERCP in patients with surgically altered anatomy remains technically challenging, not only because of the difficulty in accessing the target site but also in performing subsequent therapeutic interventions. To address these challenges, balloon enteroscopy (BE)-assisted ERCP has been introduced into clinical practice and has demonstrated both efficacy and safety. More recently, the short-type single-balloon enteroscopy (short SBE), with a working length of 152 cm and a 3.2-mm working channel, has been widely adopted, enhancing procedural efficiency. The short SBE allows the use of a wider range of accessories in various therapeutic interventions, such as stone extraction and self-expandable metallic stent placement.

This review provides a comprehensive overview of SBE-assisted ERCP, with a particular focus on short SBE. It summarizes reported procedural success and adverse event rates from previous studies and discusses factors associated with procedural failure. In addition, it highlights key technical tips, various procedural approaches using short SBE-assisted ERCP, and recent advances in relevant technologies and devices.

Despite these advancements, multiple technical challenges still need to be overcome to successfully complete the procedure. Proficiency in alternative treatments, such as endoscopic ultrasound-guided biliary drainage (EUS-BD), is also essential. The decision between BE-assisted ERCP and EUS-BD should be individualized according to the type of postoperative reconstruction, the patient's clinical status, and, importantly, the endoscopist's experience level.