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Background: The aim of the present study was to evaluate the usefulness of a single-balloon enteroscope (SBE) including a newly developed short SBE (SIF-Y0004) for therapeutic endoscopic retrograde cholangiography (ERC) in patients with Roux-en-Y (R-Y) anastomosis., Patients and Methods: Therapeutic ERC using a SBE was attempted in 19 cases (41 procedures) with R-Y anastomosis after gastrectomy. A standard SBE (working length of 200 cm, working channel of 2.8 mm) was used in 11 cases (Group L), and a short SBE (working length of 152 cm, working channel of 3.2 mm) was used in eight cases (Group S)., Results: Insertion of the scope up to the major papilla was achieved in 79% (15/19) of cases. Average insertion time was 37.0 ± 13.8 min (range, 19-62 min). Bile duct cannulation rate was 79% (11/14) after exclusion of the initial case in which scope exchange was unsuccessful. Average procedure time was78.8 ± 26.9 min (18-119 min). The scheduled therapeutic procedure was completed in 67% (10/15) of the cases (53% [10/19] on an intention-to-treat basis). Cardiorespiratory suppression due to sedative agents resulting in scope withdrawal developed in one procedure (2.4%; 1/41). Although there was no significant difference in therapeutic results between the two groups, the number of procedures was smaller (1.8 ± 1.3 vs 3.6 ± 3.1; P = 0.286) in Group S than in Group L., Conclusions: Therapeutic ERC using a SBE for patients with R-Y anastomosis is considered to be safe and effective. A short SBE appears to be promising for further improvement in therapeutic results., (© 2013 The Authors. Digestive Endoscopy © 2013 Japan Gastroenterological Endoscopy Society.)

Background/aims: Double balloon enteroscopy (DBE)-assisted endoscopic retrograde cholangiopancreatography (ERCP) is frequently performed in patients with surgically altered intestinal anatomy. Moreover, it is also utilized in some cases with pancreatic indications, particularly patients with Roux-en-Y anatomy following Whipple’s procedure or pylorus-preserving pancreaticoduodenectomy. Here, we present our experiences using DBE-assisted ERCP in patients with Roux-en-Y anatomy, with a focus on pancreatic indications., Methodology: Peroral DBE was attempted in 10 patients with Roux-en-Y anatomy. Conventional ERCP had previously been unsuccessful in all 10 patients. We retrospectively analyzed the relevant data of these patients., Results: Four patients were male (40%) and the median age of the patients was 68 years. A complete evaluation of the afferent loops was possible in eight cases (80%) and selective cannulation was successful in six cases (60%). Therapeutic interventions were tried in four patients, and were successful in all of them. We tried to approach pancreatic duct through pancreaticojejunal anastomosis and performed therapeutic intervention successfully such as removal of pancreaticoliths or dilation of stricture of pancreaticojejunostomy site in two of three patients., Conclusions: DBE-assisted ERCP appears to be a useful tool for the diagnosis and treatment of pancreatobiliary lesions in patients with a Roux-en-Y reconstruction, especially those with pancreatic indications.