Endoscopic Approach to the Bile Duct in the Patient with Surgically Altered Anatomy

Approach of the Bile Duct by Gastrostomy in Patients With Bypass in Roux-en-Y Proved to Be Safe and Effective

“…As an alternative to the use of oral duodenoscopes, several techniques have been developed, involving the use of frontal and longer vision devices [15]. Standard enteroscopy (using pediatric and enteroscopic colonoscopes) and deep one (balloon, double balloon, or spiral) help the endoscopist to overcome the challenge of transposing long segments of the small intestine and reaching the duodenal papilla.…”

“…However, new problems arise with the use of such equipment. The reduced number of compatible accessories, the approach and catheterization of the papilla with frontal view device, without forceps lift, as well as the retrograde approach of the papilla should be considered as factors that add difficulty and limit the success rates obtained with these techniques [15,17].…”

“…Another determining factor in obtaining high success rates of papilla catheterization was the presence of digestive bile anastomoses instead of the native papilla in most patients [18][19][20][21][22][23][24][25][26][27][28][29][30][31]. Increased complication rates in these procedures, including perforation and pancreatitis, have also been reported [15,20,26,30,32,33]. Furthermore, Schapira et al [34] described in 1975 the implementation of ERCP by means of preexisting gastrostomy for the evaluation of obstructive pattern jaundice.…”

“…The possibility of access to the bile duct by means of the creation of an ostomy, by means of laparoscopic or percutaneous puncture (through the use of interventional radiology techniques), in the excluded part of the stomach, allows the use of a duodenoscope in a conventional way, allowing the unrestricted use of accessories to perform ERCP. The time required for the maturation of gastrostomy for subsequent endoscopic procedure is shown as the main disadvantage of the method, making it impossible to use the technique in emergency and emergency situations [15].…”

“…Laparoscopically assisted ERCP has been gaining popularity in recent years, which may be evidenced by case reports and small published series [15]. Unlike transgastrostomy access, in which the surgical and endoscopic procedures are performed at operative times, distinct laparoscopically assisted ERCP allows the procedures to be performed at the same surgical time, and it is possible to perform them in cases of urgency [15].…”