Approaching pancreatic duct through pancreaticojejunostomy site with double ballon enteroscope in patients with Roux-en-Y anatomy.

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.