Review of diagnostic and therapeutic endoscopic retrograde cholangiopancreatography using several endoscopic methods in patients with surgically altered gastrointestinal anatomy

Figure 1 Schema of types of surgical anatomic reconstruction from gastrectomy. A: Billroth II reconstruction; B: Roux-en-Y reconstruction; C: Double-tract reconstruction; D: Jejunal pouch interposition.

Figure 2 Schema of types of surgical anatomic reconstruction from pancreaticoduodenectomy. A: The Whipple Method; B: The (modified) Child surgery; C: The Cattell Method; D: The Imanaga Method.

Figure 3 Double-balloon endoscopy. The short type double balloon enteroscope (EC- 530B; FUJIFILM, Osaka, Japan) with a working channel of 2.8 mm diameter and a working length of 152 cm.

Figure 4 Single-balloon endoscopy. The standard type double balloon enteroscope (SIF- Q260; Olympus Systems, Tokyo, Japan) with a working channel of 2.8 mm diameter and a working length of 200 cm.

Figure 5 Spiral endoscopy. Discovery SB overtube over the snteroscope.

Figure 6 Schema of double-balloon endoscopy insertion.

Figure 7 Schema of single-balloon endoscopy insertion.

Figure 8 Biliary cannulation using double-balloon endoscopy in a patient with papilla. A: Papilla when the blind end was accessed; B: Locating papilla in 6 o’clock direction in the monitor, and performing cannulation adjusting the axis of catheter into 12 o’clock direction along the biliary duct.

Figure 9 Biliary cannulation using single-balloon endoscopy in a patient with papilla. A: Papilla when the blind end was accessed; B: Locating papilla in 8-9 o’clock direction in the monitor, and performing cannulation adjusting the axis of catheter into 3 o’clock direction along the biliary duct.