BILE DUCT CANNULATION STRATEGIES FOR CASES OF SURGICALLY ALTERED GASTROINTESTINAL ANATOMY (WITH VIDEOS)

Abstract

Balloon-assisted endoscopy can facilitate most ERCP-related procedures in patients with surgically altered gastrointestinal anatomy. Nevertheless, bile duct cannulation remains technically demanding in such cases owing to anatomical modifications and the limitations of forward-viewing endoscopes, such as the lack of an elevator, and tailored procedural strategies are therefore required. This article summarizes the key considerations for deep scope insertion and bile duct cannulation according to the type of reconstruction, and describes practical techniques for bile duct cannulation using a short-type double-balloon endoscope in cases of surgically altered anatomy.