Spiral enteroscopy-assisted ERCP in bariatric length Roux-en-Y anatomy: a large single-center series and review of the literature (with video)

Deep enteroscopy-assisted ERCP (DEA-ERCP) in post-bariatric Roux-en-Y (RY) anatomy is challenging. Laparoscopy-assisted ERCP (LA-ERCP) or EUS-directed transgastric ERCP (EDGE) are technically easier and faster, but are more invasive and morbid procedures. Therefore, we have used DEA-ERCP as our first-line approach, reserving EDGE and LA-ERCP for cases in which adjunctive techniques that cannot be performed through an enteroscope are required (eg, EUS-FNA, SO manometry), or DEA-ERCP failures. The two main methods for DEA-ERCP are balloon- and spirus-assisted.

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