Technical tips for biliary cannulation for bile duct disease in patients with surgically altered gastrointestinal anatomy

Abstract

The endoscopic therapy for pancreatobiliary diseases in patients with surgically altered anatomy had been not practical until the applied use of balloon-assisted endoscope (BAE) that was originally developed as an enteroscopy made it feasible. Since the medical procedural addition points of the ERCP using BAE (BAE-ERCP) were promulgated in Japanese national health insurance, BAE-ERCP has become the first-line pancreaobiliary endoscopic treatment for postoperative cases, however, the procedure is yet to be standardized. The deep endoscopic insertion into the blind end and the ERCP-related interventions are both required to complete BAE-ERCP. The first step of ERCP-related procedures is biliary cannulation. There are two ways of accesses to biliary cannulation, one is via the papillary approach and the other is via the choledochojejunal approach. It is important to thoroughly comprehend the basics and the features of respective accesses to aim to accomplish the BAE-ERCP procedures.