Abstract
It is very difficult to reach the papilla or bilio-enteric anastomosis, and to perform the endoscopic retrograde cholangiopancreatography (ERCP) procedure in patients with a surgically altered anatomy because of the long length of the afferent limbs. Recently, a new method using a double balloon endoscope (DBE) has been able to access the afferent duodenal loop in patients with a Roux-en-Y or Billroth II anastomosis. Therefore, ERCP and associated procedures such as endoscopic sphincterotomy, balloon dilatation, biliary stenting, and biliary stone removal can also be performed in those patients. However, because the working channel of a DBE is 2.8 mm in diameter, there is a limited availability of suitable equipment, as all accessories must be thin. Many devices suitable for DBE should be made available to enable the further development of this technique. At present, no standard ERCP procedure using a DBE has yet been established. In the future, further studies are needed to establish the standard procedure of ERCP using a DBE.
