Bleeding at Roux-en-Y jejunojejunal anastomosis after orthotopic liver transplantation

Post written by Chaitanya Allamneni, MD, from the Department of Internal Medicine, University of Alabama at Birmingham, Birmingham, Alabama, USA. A young woman with a medical history of primary sclerosing cholangitis/autoimmune hepatitis overlap syndrome diagnosed at age 2, complicated by decompensated cirrhosis, underwent orthotopic liver transplantation (OLT). During OLT she underwent a standard Roux-en-Y hepaticojejunostomy. Twenty-four …

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“Two-devices-in-one-channel method” in a Roux-en-Y patient

Post written by Yohei Koyama, MD, from the Department of Gastroenterology and Hepatology, Tokyo Medical University, Tokyo, Japan. Balloon enteroscopy-assisted endoscopic retrograde cholangiopancreatography (BE-ERCP) has improved the outcomes of ERCP in patients with surgically altered anatomy. However, BE-ERCP requires high technical expertise, and biliary cannulation is often difficult. An 83-year-old man previously underwent total gastrectomy …

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Bypassing the bypass

Nikhil A. Kumta, MD from the Division of Gastroenterology and Hepatology at Weill Cornell Medical College in New York, New York, USA presents this video case, "Bypassing the bypass: EUS-directed transgastric ERCP for Roux-en-Y anatomy." Patients with altered anatomy from a Roux-en-Y gastric bypass pose distinct challenges to performing endoscopic retrograde cholangiopancreatography (ERCP). In this …

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