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World J Gastrointest Endosc. Aug 16, 2014; 6(8): 345-351
Published online Aug 16, 2014. doi: 10.4253/wjge.v6.i8.345
Endoscopic retrograde cholangiopancreatography in patients with altered anatomy: How to deal with the challenges?
Tom G Moreels
Tom G Moreels, Department of Gastroenterology and Hepatology, Cliniques Universitaires St-Luc, B-1200 Brussels, Belgium
Author contributions: Moreels TG performed the endoscopic retrograde cholangiopancreatography procedures, did the literature review and wrote the manuscript.
Correspondence to: Tom G Moreels, MD, PhD, Department of Gastroenterology and Hepatology, Cliniques Universitaires St-Luc, Hippokrateslaan 10, B-1200 Brussels, Belgium. tom.moreels@uclouvain.be
Telephone: +32-2-7642892 Fax: +32-2-7648927
Received: December 10, 2013
Revised: June 3, 2014
Accepted: June 27, 2014
Published online: August 16, 2014
Processing time: 247 Days and 10.6 Hours
Core Tip

Core tip: Endoscopic retrograde cholangiopancreatography in patients with surgically altered anatomy is difficult and faces several challenges. There are three important challenging steps in this endoscopic procedure: reaching the papilla or the bilioenteric/pancreatoenteric anastomosis, cannulation of the biliopancreatic system and prevention of endoscopic complications. Since there are no standardized practical and technical guidelines on this topic, this review illustrates these challenges with clinical cases.