Editor’s Choice: Balloon enteroscopy–assisted ERCP

Associate Editor Dr. John Saltzman highlights this article “Balloon enteroscopy–assisted ERCP in patients with Roux-en-Y gastrectomy and intact papillae (with videos)” by Ishii et al as February’s Editor’s Choice.

Performing ERCP in patients with Roux-en-Y gastric bypass (RYGB) is an increasingly common clinical scenario for advanced endoscopists. The anatomy poses unique challenges including reaching the ampulla and being able to achieve cannulation and provide therapy. This study reviews a large experience performing ERCP in this patient population and demonstrates a high procedural success rate, including a cannulation rate of >95%.

The study details the authors techniques and equipment used to achieve a successful outcome. In reviewing the details of the study, it is clear that the authors needed to use multiple methods in order to achieve this high rate of technical success.

Figure 4. Retroflex position to facilitate selective cannulation. A, Illustration of retroflex scope position. B, Fluoroscopy showing retroflex scope position. A favorable endoscopic view of the papilla is obtained (inset).

ERCP is feasible in post-RYGB however requires a high degree of expertise in both balloon-assisted small bowel enteroscopy and ERCP. Multiple techniques are needed to achieve successful outcomes. My opinion is that we need better endoscopes specifically designed for this indication as well as a fuller range of devoted ERCP accessories designed for RYGB anatomy in order to reproduce these excellent results in routine clinical practice.

Find the abstract of this article online.

The information presented in Endoscopedia reflects the opinions of the authors and does not represent the position of the American Society for Gastrointestinal Endoscopy (ASGE). ASGE expressly disclaims any warranties or guarantees, expressed or implied, and is not liable for damages of any kind in connection with the material, information, or procedures set forth.

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