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ERCP in Postsurgical Patients

  • Meir MizrahiEmail author
  • Tyler M. Berzin
  • Jeffrey D. Mosko
  • Douglas Pleskow
Chapter

Abstract

The wide array of upper gastrointestinal tract surgeries and the rising number of patients undergoing bariatric surgery for weight loss creates a significant challenge for therapeutic endoscopists attempting to perform endoscopic pancreaticobiliary procedures.

ERCP is an essential tool for a wide variety of pancreaticobiliary diseases, ranging from bile duct stones, to pancreatic adenocarcinoma to postoperative strictures of the common bile duct, including anastomosis after liver transplant.

The rate of successful ERCP with normal anatomy often exceeds 95 % in expert hands. When the upper gastrointestinal anatomy is altered, ERCP success rate declines substantially due to difficulty reaching the ampulla or the pancreaticobiliary anastomosis, and in certain cases, the difficulty of performing biliary procedures using nonstandard endoscopic equipment including balloon enteroscopes and long-length biliary catheters. Despite the challenges posed, the need for successful endoscopic approaches in these patients continues to grow over time.

Keywords

Anatomy Altered Billroth II Roux-en-Y Endoscopic retrograde cholangiopancreatography (ERCP) Balloon Enteroscopy Duodenoscope Bariatric Afferent 

Supplementary material

Video 6.1

Single balloon enteroscopy assisted ERCP (MP4 149,576 kb).

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Copyright information

© Springer International Publishing Switzerland 2016

Authors and Affiliations

  • Meir Mizrahi
    • 1
    Email author
  • Tyler M. Berzin
    • 1
  • Jeffrey D. Mosko
    • 2
  • Douglas Pleskow
    • 1
  1. 1.Division of Gastroenterology, Advanced Endoscopy Center, Beth Israel Deaconess Medical CenterHarvard Medical SchoolBostonUSA
  2. 2.Department of MedicineUniversity of TorontoTorontoCanada

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