• double‐balloon endoscopy
• ERCP
• Roux‐en‐Y reconstruction
• pancreaticoduodenectomy
• single‐balloon endoscopy

• ERCP
• altered anatomy
• balloon enteroscope
• balloon enteroscopy
• short single-balloon enteroscopy

Background and Objectives: Anatomical post-surgical alterations of the upper gastrointestinal (GI) tract have always been challenging for performing diagnostic and therapeutic endoscopy, especially when biliopancreatic diseases are involved. Esophagectomy, gastrectomy with various reconstructions and pancreaticoduodenectomy are among the most common surgeries causing upper GI tract alterations. Technological improvements and new methods have increased the endoscopic success rate in these patients, and the literature has been rapidly increasing over the past few years. The aim of this systematic review is to identify evidence on the available biliopancreatic endoscopic techniques performed in the altered post-surgical anatomy of upper GI tract. Materials and Methods: We performed a systematic search of PubMed, MEDLINE, Cochrane Library, and SCOPUS databases. Study-level variables extracted were the last name of the first author, publication year, study design, number of patients, type of post-surgical anatomical alteration, endoscopic technique, success rate and endoscopic-related adverse events. Results: Our primary search identified 221 titles, which was expanded with studies after the citation search. The final full-text review process identified 52 articles (31 retrospective studies, 8 prospective studies and 13 case reports). We found several different techniques developed over the years for biliopancreatic diseases in altered anatomy, in order to perform both endoscopic ultrasound (EUS) and endoscopic retrograde cholangiopancreatography (ERCP). They included enteroscopy-assisted ERCP (double and single balloon enteroscopy-ERCP, spiral enteroscopy-ERCP) laparoscopic assisted ERCP, EUS-Directed transgastric ERCP, EUS-directed transgastric intervention, gastric access temporary for endoscopy, and percutaneous assisted trans prosthetic endoscopic therapy. The success rate was high (most of the techniques showed a success rate over 90%) and a low rate of adverse events were reported. Conclusions: We suggest the considerationof the novel techniques when approaching patients with altered anatomy who require biliopancreatic endoscopy, focusing on the surgery type, success rate and adverse events reported in the literature.

• CH-EUS
• ERCP
• FNB
• US
• biliopancreatic endoscopy
• difficult biliary stones
• interventional EUS

• Cholangiopancreatography, Endoscopic Retrograde
• Endosonography
• Gastrectomy
• Humans
• Prospective Studies
• Retrospective Studies

• ERCP
• EUS-intervention
• balloon assisted endoscopy
• double-balloon endoscopy
• single balloon endoscopy

Background: Endoscopic retrograde cholangiopancreatography (ERCP) for extraction of common bile duct (CBD) stones in patients with Roux-en-Y gastrectomy (RYG) remains technically challenging. Methods: Seventy-nine RYG patients (median 79 years old) underwent short-type double-balloon enteroscopy-assisted ERCP (sDBE-ERCP) for CBD stones at three referral hospitals from 2011–2020. We retrospectively investigated the treatment outcomes and potential factors affecting complete stone extraction. Results: The initial success rates of reaching the papilla of Vater, biliary cannulation, and biliary intervention, including complete stone extraction or biliary stent placement, were 92%, 81%, and 78%, respectively. Of 57 patients with attempted stone extraction, complete stone extraction was successful in 74% for the first session and ultimately in 88%. The adverse events rate was 5%. The multivariate analysis indicated that the largest CBD diameter ≥ 14 mm (odds ratio (OR), 0.04; 95% confidence interval (CI), 0.01–0.58; p = 0.018) and retroflex position (OR, 6.43; 95% CI, 1.12–36.81; p = 0.037) were independent predictive factors affecting complete stone extraction achievement. Conclusions: Therapeutic sDBE-ERCP for CBD stones in a relatively elderly RYG cohort, was effective and safe. A larger CBD diameter negatively affected complete stone extraction, but using the retroflex position may be useful for achieving complete stone clearance.

• Roux-en-Y anastomosis
• bile duct stone
• complete stone removal
• endoscopic retrograde cholangiography
• gastrectomy
• short-type balloon enteroscopy

Success rates of balloon enteroscopy-assisted endoscopic retrograde cholangiopancreatography (BE-ERCP) for patients with a reconstructed intestinal tract after surgical procedures are unsatisfactory. We retrospectively investigated the factors associated with unsuccessful BE-ERCP. Ninety-one patients who had a reconstructed intestinal tract after gastrectomy or choledochojejunostomy were enrolled. Age, sex, operative method, malignancy, endoscope type, endoscopist’s skill, emergency procedure, and time required to reach the papilla/anastomosis were examined. The primary endpoints were the factors associated with unsuccessful BE-ERCP selective cannulation, while the secondary endpoints were the rate of reaching the papilla/anastomosis, causes of failure to reach the papilla/anastomosis, cannulation success rate, procedure success rate, and rate of adverse events. Younger age (odds ratio, 0.832; 95% CI, 0.706–0.982; p = 0.001) and Roux-en-Y partial gastrectomy (odds ratio, 54.9; 95% CI, 1.09–2763; p = 0.045) were associated with unsuccessful BE- ERCP. The rate of reaching the papilla/anastomosis was 92.3%, the success rate of biliary duct cannulation was 90.5%, procedure success rate was 78.0%, and the rate of adverse events was 5.6%. In conclusion, Roux-en-Y partial gastrectomy and younger age were associated with unsuccessful BE-ERCP. If BE-ERCP is extremely difficult to perform in such patients after Roux-en-Y partial gastrectomy, alternative procedures should be considered early.

• Roux-en-Y anastomosis
• balloon enteroscopy
• biliary intervention
• endoscopic retrograde cholangiography

• Endoscopic retrograde cholangiopancreatography;
• malignant biliary obstruction;
• self-expandable metallic stent;
• single-balloon enteroscopy;
• surgically altered anatomy

• balloon-assisted enteroscopy
• biliary obstruction
• complications.
• endoscopic retrograde cholangiopancreatography
• roux-en-y anastomosis
• whipple operation

• Adult
• Anastomosis, Roux-en-Y
• Balloon Enteroscopy
• Child, Preschool
• Cholangiopancreatography, Endoscopic Retrograde
• Female
• Humans
• Male
• Middle Aged
• Postoperative Complications
• Retrospective Studies

• Billroth II reconstruction
• Colonoscope
• Endoscopic retrograde cholangiopancreatography
• Esophagogastroduodenoscope

• Balloon enteroscopy
• Bilioenteric stricture
• Endoscopic balloon dilation
• Surgically altered anatomy

• endoscopic retrograde cholangiopancreatography
• factors involved in procedural failure
• response to procedural failure
• short-type single-balloon enteroscope
• surgically altered gastrointestinal anatomy

Endoscopic retrograde cholangiopancreatography (ERCP) in patients with surgically altered anatomy must be performed by a highly experienced endoscopist. The challenges are accessing the afferent limb in different types of reconstruction, cannulating a papilla with a reverse orientation, and performing therapeutic interventions with uncommon endoscopic accessories. The development of endoscopic techniques has led to higher success rates in this group of patients. Device-assisted ERCP is the endoscopic procedure of choice for high success rates in short-limb reconstruction; however, these success rate is lower in long-limb reconstruction. ERCP assisted by endoscopic ultrasonography is now popular because it can be performed independent of the limb length; however, it must be performed by a highly experienced and skilled endoscopist. Stent deployment and small stone removal can be performed immediately after ERCP assisted by endoscopic ultrasonography, but the second session is needed for other difficult procedures such as cholangioscopy-guided electrohydraulic lithotripsy. Laparoscopic-assisted ERCP has an almost 100% success rate in long-limb reconstruction because of the use of a conventional side-view duodenoscope, which is compatible with standard accessories. This requires cooperation between the surgeon and endoscopist and is suitable in urgent situations requiring concomitant cholecystectomy. This review focuses on the advantages, disadvantages, and outcomes of various procedures that are suitable in different situations and reconstruction types. Emerging new techniques and their outcomes are also discussed.

• : Endoscopic retrograde cholangiopancreatography
• Surgically altered anatomy
• Endoscopic retrograde cholangiopancreatography in Billroth II
• Endoscopic retrograde cholangiopancreatography post-Whipple
• Endoscopic ultrasonography-guided endoscopic retrograde cholangiopancreatography

• Biliary Tract/diagnostic imaging
• Cholangiopancreatography, Endoscopic Retrograde/instrumentation
• Cholangiopancreatography, Endoscopic Retrograde/methods
• Cholecystectomy/instrumentation
• Cholecystectomy/methods
• Duodenoscopes
• Endosonography
• Gastrectomy/adverse effects
• Gastrectomy/methods
• Gastric Bypass/instrumentation
• Gastric Bypass/methods
• Humans
• Laparoscopy/instrumentation
• Laparoscopy/methods
• Pancreaticoduodenectomy/adverse effects
• Pancreaticoduodenectomy/methods
• Plastic Surgery Procedures/instrumentation
• Plastic Surgery Procedures/methods
• Stents
• Treatment Outcome
• Ultrasonography, Interventional

Failure factors in reaching the blind end (papillae of Vater, bilioenteric anastomosis) during short-type single-balloon enteroscope-assisted endoscopic retrograde cholangiopancreatography (sSBE-assisted ERCP) in patients with Roux-en-Y (R-Y) reconstruction remain to be evaluated.

We investigated the failure factors in such patients.

We retrospectively studied 253 initial sessions of sSBE-assisted ERCP at three endoscopy centers from April 2008 through September 2017, examining failure factors and complications associated with scope insertion in patients with R-Y reconstruction.

R-Y reconstruction was performed in 157 patients (with gastrectomy: 122 patients; without gastrectomy plus bilioenteric anastomosis: 35 patients). R-Y without gastrectomy (p = 0.001; odds ratio (OR), 5.73; 95% confidence interval (CI), 2.07 to 16.01) and the presence of peritoneal dissemination (p = 0.021; OR, 4.71; 95% CI, 1.27 to 17.54) were significant failure factors. Insufficient sSBE length was the cause of failure in 17 (11%) of the 157 patients, and 13 (76%) of the 17 patients were with R-Y without gastrectomy. In cases of insufficient short-type length, using a long-type SBE significantly increased the success rate (p = 0.002). Gastrointestinal stenosis was a significant failure factor (p = 0.011) in patients with peritoneal dissemination. Perforation occurred in 2 patients who responded to conservative treatment.

Failure factors during sSBE-assisted ERCP were R-Y without gastrectomy and the presence of peritoneal dissemination.

• BAE, balloon-assisted enteroscopy

• Cholangitis
• Hepaticojejunostomy
• Roux-en-Y surgery

• Billroth II
• ERCP
• Malignant hilar biliary obstruction
• Self-expandable metal stent
• Side-by-side
• Two-channel endoscope

• Aged
• Aged, 80 and over
• Cholestasis/diagnostic imaging
• Cholestasis/etiology
• Cholestasis/therapy
• Digestive System Neoplasms/complications
• Digestive System Neoplasms/pathology
• Digestive System Neoplasms/surgery
• Endoscopes
• Endoscopy, Digestive System/adverse effects
• Endoscopy, Digestive System/instrumentation
• Female
• Gastroenterostomy/adverse effects
• Humans
• Kaplan-Meier Estimate
• Male
• Prosthesis Design
• Recurrence
• Retrospective Studies
• Self Expandable Metallic Stents
• Time Factors
• Treatment Outcome

• Billroth II operation
• Duodenoscopes
• Endoscopes
• Endoscopic retrograde cholangiopancreatography
• Meta-analysis

• endoscopic ultrasound
• late complication
• pancreaticoduodenectomy
• pancreaticojejunostomy stricture
• rendezvous technique

• Adult
• Cholangiopancreatography, Endoscopic Retrograde/adverse effects
• Cholangiopancreatography, Endoscopic Retrograde/methods
• Constriction, Pathologic/diagnostic imaging
• Constriction, Pathologic/etiology
• Constriction, Pathologic/surgery
• Endoscopy/methods
• Female
• Humans
• Male
• Middle Aged
• Pancreatic Ducts/diagnostic imaging
• Pancreaticoduodenectomy/adverse effects
• Pancreaticoduodenectomy/methods
• Pancreaticojejunostomy/adverse effects
• Punctures
• Treatment Outcome
• Young Adult

• Cholangitis
• Drainage
• Endoscopic retrograde cholangiopancreatography
• Endoscopic sphincterotomy
• Gallstones

• Altered gastrointestinal anatomy
• ERCP (Endoscopic retrograde cholangiopancreatography)
• Peroral direct cholangioscopy
• Roux-en-Y
• Short type single-balloon enteroscope

• DBE-assisted ERC
• Roux-en-Y reconstruction
• endoscopic retrograde cholangiography (ERC)
• short-type double-balloon endoscopy (DBE)

Obesity is a growing problem in developed countries, and surgery is the most effective treatment in terms of weight loss and improving medical comorbidity in a high proportion of obese patients. Despite the advances in surgical techniques, some patients still develop acute and late postoperative complications, and an endoscopic evaluation is often required for diagnosis. Moreover, the high morbidity related to surgical reintervention, the important enhancement of endoscopic procedures and technological innovations introduced in endoscopic equipment have made the endoscopic approach a minimally-invasive alternative to surgery, and, in many cases, a suitable first-line treatment of bariatric surgery complications. There is now evidence in the literature supporting endoscopic management for some of these complications, such as gastrointestinal bleeding, stomal and marginal ulcers, stomal stenosis, leaks and fistulas or pancreatobiliary disorders. However, endoscopic treatment in this setting is not standardized, and there is no consensus on its optimal timing. In this article, we aim to analyze the secondary complications of the most expanded techniques of bariatric surgery with special emphasis on those where more solid evidence exists in favor of the endoscopic treatment. Based on a thorough review of the literature, we evaluated the performance and safety of different endoscopic options for every type of complication, highlighting the most recent innovations and including comparative data with surgical alternatives whenever feasible.

• Bariatric surgery
• Bariatric complications
• Endoscopic treatment
• Leaks
• Stenosis
• Sleeve gastrectomy
• Gastric Roux-en-Y bypass

• ERCP
• Medications
• Pancreatitis
• Prevention
• Stents

Roux-en-Y reconstructive surgery excludes the biliopancreatic system from conventional endoscopic access. Balloon-assisted enteroscopy allows therapeutic endoscopic retrograde cholangiopancreatography (ERCP) in these patients, avoiding rescue surgery.

The objective of the current study is to compare success and complication rate of double-balloon (DBE) and single-balloon enteroscope (SBE) to perform ERCP in Roux-en-Y patients.

Seventy three Roux-en-Y patients with suspected biliary tract pathology underwent balloon-assisted enteroscopy in a tertiary-care center. Retrospective analysis of 95 consecutive therapeutic ERCP procedures was performed to define and compare success and complication rate of DBE and SBE.

Male-female ratio was 28/45 with a mean age of 58 ± 2 years. 30 (32 %) procedures were performed with DBE and 65 (68 %) with SBE. Overall ERCP success rate was 73 % for DBE and 75 % for SBE (P = 0.831). Failure was due to inability to reach or cannulate the intact papilla or bilioenteric anastomosis. Success rate was significantly higher when performed at the bilioenteric anastomosis (80 % success in 56 procedures) or at the intact papilla in short-limb Roux-en-Y (80 % in 15 procedures) as compared to the intact papilla in long-limb (58 % in 24 procedures; P = 0.040). Adverse event rates were 10 % (DBE) and 8 % (SBE) (P = 0.707) and mostly dealt with conservatively.

ERCP after Roux-en-Y altered small bowel anatomy is feasible and safe using both DBE and SBE. Both techniques are equally competent with high success rates and acceptable adverse events rates. ERCP at the level of the intact papilla in long limb Roux-en-Y is less successful as compared to short-limb or bilioenteric anastomosis.

• Balloon-assisted enteroscopy
• ERCP
• Roux-en-Y

• ERCP
• Malignant biliary obstruction
• Metal stent
• Single-balloon enteroscope
• Surgically altered anatomy

• side-viewing duodenoscope
• endoscopic retrograde cholangiopancreatography
• postgastrectomy
• retrieval balloon–assisted enterography
• optimal ercp enterography route

The endoscopic approach for biliary diseases in patients with surgically altered gastrointestinal anatomy (SAGA) had been generally deemed impractical. However, it was radically made feasible by the introduction of double balloon endoscopy (DBE) that was originally developed for diagnosis and treatments for small-bowel diseases. Followed by the subsequent development of single-balloon endoscopy (SBE) and spiral endoscopy (SE), interventions using several endoscopes for biliary disease in patients with SAGA widely gained an acceptance as a new modality. Many studies have been made on this new technique. Yet, some problems are to be solved. For instance, the mutual unavailability among devices due to different working lengths and channels, and unestablished standardization of procedural techniques can be raised. Additionally, in an attempt to standardize endoscopic procedures, it is important to evaluate biliary cannulating methods by case with existence of papilla or not. A full comprehension of the features of respective scope types is also required. However there are not many papers written as a review. In our manuscript, we would like to evaluate and make a review of the present status of diagnostic and therapeutic endoscopic retrograde cholangiopancreatography applying DBE, SBE and SE for biliary diseases in patients with SAGA for establishment of these modalities as a new technology and further improvement of the scopes and devices.

• Double balloon endoscopy
• Single balloon endoscopy
• Spiral endoscopy
• Endoscopic retrograde cholangiopancreatography
• Roux-en-Y reconstruction

Endoscopic retrograde cholangiopancreatography (ERCP) remains challenging in patients who have undergone surgical reconstruction of the intestine. Recently, many studies have reported that balloon-enteroscope-assisted ERCP (BEA-ERCP) is a safe and effective procedure. However, further improvements in outcomes and the development of simplified procedures are required. Percutaneous treatment, Laparoscopy-assisted ERCP, endoscopic ultrasound-guided anterograde intervention, and open surgery are effective treatments. However, treatment should be noninvasive, effective, and safe. We believe that these procedures should be performed only in difficult-to-treat patients because of many potential complications. BEA-ERCP still requires high expertise-level techniques and is far from a routinely performed procedure. Various techniques have been proposed to facilitate scope insertion (insertion with percutaneous transhepatic biliary drainage (PTBD) rendezvous technique, Short type single-balloon enteroscopes with passive bending section, Intraluminal injection of indigo carmine, CO₂ inflation guidance), cannulation (PTBD or percutaneous transgallbladder drainage rendezvous technique, Dilation using screw drill, Rendezvous technique combining DBE with a cholangioscope, endoscopic ultrasound-guided rendezvous technique), and treatment (overtube-assisted technique, Short type balloon enteroscopes) during BEA-ERCP. The use of these techniques may allow treatment to be performed by BEA-ERCP in many patients. A standard procedure for ERCP yet to be established for patients with a reconstructed intestine. At present, BEA-ERCP is considered the safest and most effective procedure and is therefore likely to be recommended as first-line treatment. In this article, we discuss the current status of BEA-ERCP in patients with surgically altered gastrointestinal anatomy.

• Balloon enteroscopy
• Endoscopic retrograde cholangiopancreatography
• Altered gastrointestinal anatomy
• Balloon-enteroscope-assisted endoscopic retrograde cholangiopancreatography

• Biliary Tract Diseases/diagnosis
• Biliary Tract Diseases/surgery
• Cholangiopancreatography, Endoscopic Retrograde/adverse effects
• Cholangiopancreatography, Endoscopic Retrograde/instrumentation
• Cholangiopancreatography, Endoscopic Retrograde/methods
• Endoscopes
• Equipment Design
• Humans
• Intestines/surgery
• Laparoscopy
• Pancreatic Diseases/diagnosis
• Pancreatic Diseases/surgery
• Patient Selection
• Plastic Surgery Procedures/adverse effects
• Risk Assessment
• Risk Factors
• Treatment Outcome

AIM: To evaluate short-type-single-balloon enteroscope (SBE) with passive-bending, high-force transmission functions for endoscopic retrograde cholangiopancreatography (ERCP) in patients with Roux-en-Y anastomosis.

METHODS: Short-type SBE with this technology (SIF-Y0004-V01; working length, 1520 mm; channel diameter, 3.2 mm) was used to perform 50 ERCP procedures in 37 patients with Roux-en-Y anastomosis. The rate of reaching the blind end, time required to reach the blind end, diagnostic and therapeutic success rates, and procedure time and complications were studied retrospectively and compared with the results of 34 sessions of ERCP performed using a short-type SBE without this technology (SIF-Y0004; working length, 1520 mm; channel diameter, 3.2 mm) in 25 patients.

RESULTS: The rate of reaching the blind end was 90% with SIF-Y0004-V01 and 91% with SIF-Y0004 (P = 0.59). The median time required to reach the papilla was significantly shorter with SIF-Y0004-V01 than with SIF-Y0004 (16 min vs 24 min, P = 0.04). The diagnostic success rate was 93% with SIF-Y0004-V01 and 84% with SIF-Y0004 (P = 0.17). The therapeutic success rate was 95% with SIF-Y0004-V01 and 96% with SIF-Y0004 (P = 0.68). The median procedure time was 40 min with SIF-Y0004-V01 and 36 min with SIF-Y0004 (P = 0.50). The incidence of hyperamylasemia was 6.0% in the SIF-Y0004-V01 group and 14.7% in the SIF-Y0004 group (P = 0.723). The incidence of pancreatitis was 0% in the SIF-Y0004-V01 group and 5.9% in the SIF-Y0004 group (P > 0.999). The incidence of gastrointestinal perforation was 2.0% (1/50) in the SIF-Y0004-V01 group and 2.9% (1/34) in the SIF-Y0004 group (P > 0.999).

CONCLUSION: SIF-Y0004-V01 is useful for ERCP in patients with Roux-en-Y anastomosis and may reduce the time required to reach the blind end.

• Passive bending
• Roux-en-Y anastomosis
• Endoscopic retrograde cholangiopancreatography
• Short type
• Single-balloon enteroscope

• Aged
• Aged, 80 and over
• Anastomosis, Roux-en-Y/adverse effects
• Cholangiopancreatography, Endoscopic Retrograde/adverse effects
• Cholangiopancreatography, Endoscopic Retrograde/instrumentation
• Digestive System Diseases/diagnosis
• Digestive System Diseases/surgery
• Endoscopes, Gastrointestinal
• Equipment Design
• Female
• Humans
• Hyperamylasemia/etiology
• Intestinal Perforation/etiology
• Intestine, Small/surgery
• Male
• Middle Aged
• Operative Time
• Pancreatitis/etiology
• Predictive Value of Tests
• Retrospective Studies
• Risk Factors
• Time Factors
• Treatment Outcome

• altered gastrointestinal anatomy
• balloon-assisted enteroscopy (BAE)
• endoscopic retrograde cholangiopancreatography (ERCP)
• prototype
• single-balloon enteroscopy (SBE)

• anterior oblique-viewing endoscope
• balloon enteroscope
• endoscopic retrograde cholangiopancreatography
• billroth ii gastrectomy
• roux-en-y anastomosis

Over the past decade the ability of endoscopists to access the biliary tree in patients with surgically altered gastroduodenal anatomy has significantly advanced. Much of the progress has occurred as a result of the development of better tools to navigate the deep small bowel, such as single-balloon- (SBE), double-balloon- (DBE), and spiral-enteroscopy-assisted endoscopic retrograde cholangiopancreatography (ERCP). However, despite using a cap, accessing the papilla or bile duct using these forward-viewing enteroscopy platforms remains challenging, even in expert hands. In patients with Roux-en-Y gastric bypass (RYGB) anatomy, the excluded stomach is a potential point of access for either a delayed transgastric- or immediate laparoscopy-assisted-ERCP approach. However, the parallel advancement of therapeutic endoscopic ultrasound (EUS) also provides alternative approaches through which the biliary system can be accessed and intervened on in patients with surgically altered anatomies. Generally speaking, in patients with short gastro-jejunal “Roux” and bilio-pancreatic limbs, ideally less than 150 cm in length, starting with a (cap-assisted) push-enteroscopy or balloon-enteroscopy approach would offer reasonable diagnostic and therapeutic ERCP success. When available, short-SBE or short-DBE scopes should be used, as they allow the use of conventional ERCP equipment, are associated with shorter procedure times, and are easier to manipulate. In patients with RYGB who have longer Roux and/or bilio-pancreatic limbs (> 150 cm in total length), or in patients who have failed prior attempts at deep enteroscopy-assisted ERCP, transgastric laparoscopy-assisted-ERCP is associated with higher rates of diagnostic and therapeutic success as compared to deep-enteroscopy-assisted ERCP. Finally, EUS-guided biliary access for antegrade biliary intervention or for rendezvous enteroscopy-assisted ERCP is possible. While percutaneous transhepatic biliary drainage and surgical bile duct exploration remain viable alternatives, these methods are not without significant morbidity and mortality and should only be considered if less invasive endoscopic interventions are not feasible or appropriate.

• Endoscopic retrograde cholangiopancreatography
• Bile duct
• Roux-en-Y
• Gastric bypass
• Surgically altered anatomy

• endoscopic retrograde cholangiopancreaticography
• single balloon
• single balloon enteroscopy endoscopic retrograde cholangiopancreaticography
• surgically altered anatomy

• Billroth-II gastrectomy
• Roux-en-Y reconstruction
• biliary cannulation
• endoscopic retrograde cholangiopancreatography (ERCP)
• single-balloon endoscopy

• Billroth-II anastomosis
• Roux-en-Y anastomosis
• endoscopic retrograde cholangiopancreatography (ERCP)
• short-type SBE
• single-balloon enteroscope (SBE)

• Roux-en-Y anastomosis
• endoscopic papillary balloon dilation (EPBD)
• endoscopic papillary large-balloon dilation (EPLBD)
• endoscopic sphincterotomy (EST)
• enteroscopy

• Roux-en-Y
• balloon-assisted enteroscopy
• endoscopic retrograde cholangiopancreatography (ERCP)
• hepaticojejunostomy
• single-balloon enteroscopy

• double-balloon enteroscope
• endoscopic retrograde cholangiopancreatography (ERCP)
• single-balloon enteroscope
• surgically altered anatomy