Endoscopic retrograde cholangiopancreatography in patients with surgically altered anatomy using balloon-assisted enteroscope.

Endoscopic retrograde cholangiopancreatography (ERCP) in patients with surgically altered anatomy involves challenging procedures for ERCP endoscopists. In these patients, the anatomical structure of the intestine is substantially altered, and an endoscope needs to be inserted into the long afferent limb. Moreover, the papilla is observed in the opposite view from the normal anatomy. Recently, a balloon-assisted enteroscope (BAE) has been developed and made available for use in daily practice. The two types of BAE are single-balloon enteroscope (SBE), which is inserted with one balloon attached to the overtube using a balloon-assisted method, and double-balloon enteroscope (DBE), which is inserted with two balloons, one attached to the overtube and the other attached to the tip of the enteroscope. In addition, short-type DBE (short-DBE) and short-type SBE (short-SBE) with a working length of approximately 150 cm, which could be used with various ERCP accessories, are commercially available or under development. Notably, the success rate of ERCP through coordinated manipulation with a balloon was remarkably improved with the use of BAE, even in patients with surgically altered anatomy. Here, we report the current status and procedures of ERCP in patients with surgically altered anatomy.