ERCP with the Double Balloon Enteroscope in Patients with Roux-en-Y Anastomosis

Endoscopic retrograde cholangiopancreatography (ERCP) is technically more challenging in patients with postsurgical anatomy, such as Roux-en-Y anastomosis, frequently mandating an operative intervention. Although limited, there is growing evidence that ERCP can be performed using the double balloon enteroscope (DBE) in patients with complex postoperative anatomy. We present the technical aspects of performing ERCP with the DBE in patients presenting with complex postsurgical anatomy having biliary problems. ERCP using the DBE is feasible in patients with complex postsurgical anatomy, permitting diagnostic and therapeutic interventions in 80% of patients.