caa a22 4500 605494746 CHVBK 20210128100527.0 cr unu---uuuuu 210128e20151001xx s 000 0 eng 10.1007/s00261-015-0532-7 doi (NATIONALLICENCE)springer-10.1007/s00261-015-0532-7 Endoscopic retrograde cholangiopancreatography in patients with surgically altered gastrointestinal anatomy [Elektronische Daten] [Syed Amer, Jennifer Horsley-Silva, Christine Menias, Rahul Pannala] Endoscopic retrograde cholangiopancreatography (ERCP) in patients with surgically altered upper gastrointestinal anatomy, such as Roux-en-Y gastric bypass (RYGB), can be more challenging compared to those with a normal anatomy. Detailed assessment of cross-sectional imaging features by the radiologist, especially the pancreaticobiliary anatomy, strictures, and stones, is very helpful to the endoscopist in planning the procedure. In addition, any information on enteral anastomoses (for e.g., gastrojejunal strictures and afferent limb obstruction) is also very useful. The endoscopist should review the operative note to understand the exact anatomy prior to procedure. RYGB, which is performed for medically complicated obesity, is the most commonly encountered altered anatomy ERCP procedure. Other situations include patients who have had a pancreaticoduodenectomy or a hepaticojejunostomy. Balloon-assisted deep enteroscopy (single and double-balloon enteroscopy) or rotational endoscopy is often used to traverse the length of the intestine to reach the papilla. In addition, ERCP in these patients is further challenging due to the oblique orientation of the papilla relative to the forward viewing endoscope and the limited enteroscopy-length therapeutic accessories that are currently available. Overall, reported therapeutic success is approximately 70-75% with a complication rate of 3-4%. Alternative approaches include percutaneous transhepatic cholangiography, laparoscopy-assisted ERCP, or surgery. Given the complexity, ERCP in patients with surgically altered anatomy should be performed in close collaboration with body imagers, interventional radiology, and surgical services. Springer Science+Business Media New York, 2015 ERCP nationallicence Surgically altered anatomy nationallicence Abdominal imaging nationallicence Roux-en-Y gastric bypass nationallicence ERCP : Endoscopic retrograde cholangiopancreatography nationallicence RYGB : Roux-en-Y gastric bypass nationallicence DBE : Double-balloon enteroscopy nationallicence SBE : Single-balloon enteroscopy nationallicence SE : Spiral enteroscopy nationallicence PTC : Percutaneous transhepatic cholangiography nationallicence EUS-CP : Endoscopic ultrasound-guided cholangiopancreatography nationallicence LA-ERCP : Laparoscopy-assisted endoscopic retrograde cholangiopancreatography nationallicence US : Ultrasound nationallicence Amer Syed Division of Internal Medicine, Mayo Clinic, Scottsdale, AZ, USA aut Horsley-Silva Jennifer Division of Gastroenterology and Hepatology, Mayo Clinic, Phoenix, AZ, USA aut Menias Christine Division of Radiology, Mayo Clinic, Scottsdale, AZ, USA aut Pannala Rahul Division of Gastroenterology and Hepatology, Mayo Clinic, Phoenix, AZ, USA aut Abdominal Imaging Springer US; http://www.springer-ny.com 40/8(2015-10-01), 2921-2931 0942-8925 40:8<2921 2015 40 261 https://doi.org/10.1007/s00261-015-0532-7 text/html Onlinezugriff via DOI BK010053 XK010053 XK010000 Metadata rights reserved Springer special CC-BY-NC licence nationallicence 1 research-article jats NATIONALLICENCE NATIONALLICENCE NL-springer NATIONALLICENCE 856 40 https://doi.org/10.1007/s00261-015-0532-7 text/html Onlinezugriff via DOI NATIONALLICENCE 700 1- Amer Syed Division of Internal Medicine, Mayo Clinic, Scottsdale, AZ, USA aut NATIONALLICENCE 700 1- Horsley-Silva Jennifer Division of Gastroenterology and Hepatology, Mayo Clinic, Phoenix, AZ, USA aut NATIONALLICENCE 700 1- Menias Christine Division of Radiology, Mayo Clinic, Scottsdale, AZ, USA aut NATIONALLICENCE 700 1- Pannala Rahul Division of Gastroenterology and Hepatology, Mayo Clinic, Phoenix, AZ, USA aut NATIONALLICENCE 773 0- Abdominal Imaging Springer US; http://www.springer-ny.com 40/8(2015-10-01), 2921-2931 0942-8925 40:8<2921 2015 40 261