ERCP using single-balloon instead of double-balloon enteroscopy in patients with Roux-en-Y anastomosis

Abstract

A 60-year-old man underwent pancreatic necrosectomy and a Roux-en-Y anastomosis. Before surgery the patient had undergone an endoscopic retrograde cholangiopancreatography (ERCP) with biliary stent placement, but this stent could not be removed intra-operatively. ERCP was carried out using the Fujinon double-balloon enteroscope (EN-450T5I, Fujinon, Saitama, Japan). For the ERCP we did not place a balloon on the tip of the enteroscope. Advancement of the enteroscope and overtube was accomplished using the push-and-pull method. Once the anastomosis was localized, the overtube was advanced towards the tip of the scope and the balloon was inflated. The enteroscope was then advanced into the afferent loop, and once it was 20 cm inside of the loop, the overtube balloon was deflated and advanced towards the tip of the scope. These push-and-pull maneuvers were repeated until the pouch of the afferent limb was visualized. The protruding stent helped localize the major papilla ([Fig. 1]). The stent was then grasped with a snare and retrieved ([Fig. 2]).