roux-en-Y reconstruction: case series and review of the literature

background: Endoscopic access to the biliary system can be difficult in patients with surgically altered anatomy, such as a roux-en-Y reconstruction. double balloon enteroscopy (dbE) is a relatively new procedure that enables access to the small bowel. dbE has recently been advocated as a method for endoscopic retrograde cholangiopancreaticography (ErCP) in patients with surgical reconstructions, with the potential to perform diagnostic and therapeutic interventions. Methods: in three patients with a hepaticojejunostomy and roux-en-Y reconstruction, the experiences using dbE to perform ErCP are described. The literature on db-ErCP in patients with a roux-en-Y reconstruction was reviewed. results: in all patients, the roux limb was entered and a diagnostic cholangiography was carried out. in one patient, endoscopic therapy could be performed, consisting of balloon dilation of a stenotic biliodigestive anastomosis, repeated balloon dilation of biliary strictures and removal of bile casts. Conclusion: This series confirms recent data emerging from the literature that double balloon enteroscopy is a safe and feasible technique to obtain biliary access in patients with surgically altered anatomical configurations, such as those with a roux-en-Y reconstruction. The diagnostic and therapeutic potential of db-ErCP is great, and the utility of the procedure could be further improved if customised accessories become more widely available.