Springer Nature is making SARS-CoV-2 and COVID-19 research free. View research | View latest news | Sign up for updates

Endoscopic retrograde cholangiography by double balloon enteroscopy in patients with Roux-en-Y hepaticojejunostomy

  • 325 Accesses

  • 51 Citations



In patients with Roux-en-Y hepaticojejunostomy (HJ), endoscopic retrograde cholangiography (ERC) cannot usually be achieved since the anastomosis is not reachable via standard duodenoscope. In this study, we report our experience with ERC using double balloon enteroscope (DBE) (DBE-ERC) in patients with HJ.


The DBE-ERC procedures performed since the index case done dated May 3, 2006 have been overviewed.


Fourteen patients underwent the procedure. DBE-ERC was successful in all but one patient, for whom the anastomosis could not be reached (success rate to reach anastomosis: 92.9%). The remaining 13 patients (7 female, 6 male; age 28–61 years, mean 45.3 years) had 20 sessions of DBE-ERC. The cannulation of the bile duct was achieved in all patients. The procedures, such as sphincteroplasty, dilatation, stone extraction and stent placement, were performed. Therapeutic procedures were all successful, except for in a single patient, who had the common bile duct filled with multiple stones and was referred for surgery. Three patients who had anastomotic stenosis treated by stenting are symptom free on follow-up at 3, 9 and 12 months, respectively, after stent removal. Retroperitoneal air was detected in a patient following stricturoplasty, but recovery was attained with medical treatment alone. Mean duration of the procedures was 75 ± 62 min.


DBE-ERCP enables us to perform ERC in a group of patients for whom it was impossible previously. Further experience is needed to evaluate its therapeutic efficacy compared with alternative methods.

This is a preview of subscription content, log in to check access.

Fig. 1
Fig. 2
Fig. 3


  1. 1.

    Feitoza AB, Baron TH (2001) Endoscopy and ERCP in the setting of previous upper GI tract surgery. Part I: reconstruction without alteration of pancreaticobiliary anatomy. Gastrointest Endosc 54:743–749

  2. 2.

    Baron TH, Vickers SM (1998) Surgical gastrostomy placement as access for diagnostic and therapeutic ERCP. Gastrointest Endosc 48:640–641

  3. 3.

    Yamamoto H, Sekine Y, Sato Y (2001) Total enteroscopy with a nonsurgical steerable double-balloon method. Gastrointest Endosc 53:216–220

  4. 4.

    Haruta H, Yamamoto H, Mizuta K (2005) A case of successful enteroscopic balloon dilation for late anastomotic stricture of choledochojejunostomy after living donor liver transplantation. Liver Transpl 11:1608–1610

  5. 5.

    Moreels TG, Roth B, Vandervliet EJ, Parizel PM, Dutré J, Pelckmans PA (2007) The use of the double-balloon enteroscope for endoscopic retrograde cholangiopancreatography and biliary stent placement after Roux-en-Y hepaticojejunostomy. Endoscopy 39(suppl 1):E196–E197

  6. 6.

    Spahn TW, Grosse-Thie W, Spies P, Mueller MK (2007) Treatment of choledocholithiasis following Roux-en-Y hepaticojejunostomy using double-balloon endoscopy. Digestion 75:20–21

  7. 7.

    Mehdizadeh S, Ross A, Gerson L, Leighton J, Chen A, Schembre D et al (2006) What is the learning curve associated with double-balloon enteroscopy? Technical details and early experience in 6 U.S. tertiary care centers. Gastrointest Endosc 64:740–750

  8. 8.

    Aabakken L, Bretthauer M, Line PD (2007) Double-balloon enteroscopy for endoscpic retrograde cholangiography in patients with Roux-en-Y anastomosis. Endoscopy 39:1068–1071

  9. 9.

    Emmett DS, Mallat D (2007) Double-balloon ERCP in patients who have undergone Roux-en-Y surgery: a case series. Gastrointest Endosc 66:1038–1041

  10. 10.

    Maaser C, Lenze F, Bokemeyer M, Ullerich H, Domagk D, Bruewer M et al (2008) Double balloon enteroscopy: a useful tool for diagnostic and therapeutic procedures in the pancreaticobiliary system. Am J Gastroenterol 103:894–900

  11. 11.

    Koornstra JJ (2008) Double balloon enteroscopy for endoscopic retrograde cholangiopancreaticography after Roux-en-Y reconstruction: case series and review of the literature. Neth J Med 66:275–279

  12. 12.

    Mönkemüller K, Bellutti M, Neumann H, Malfertheiner P (2008) Therapeutic ERCP with the double-balloon enteroscope in patients with Roux-en-Y anastomosis. Gastrointest Endosc 67:992–996

  13. 13.

    Cotton PB, Lehman G, Vennes J (1991) Endoscopic sphincterotomy complications and their management: an attempt at consensus. Gastrointest Endosc 37:383–393

  14. 14.

    Vos PM, van Beek JR, Smits NJ (2000) Percutaneous balloon dilatation for benign hepaticojejunostomy strictures. Abdom Imaging 25:134–138

  15. 15.

    Chaudhary A, Chandra A, Negi SS (2002) Reoperative surgery for postcholecystectomy bile duct injuries. Dig Surg 19:22–27

  16. 16.

    Costamagna G, Shah SK, Tringali A (2003) Current management of postoperative complications and benign biliary strictures. Gastrointest Endoscopy Clin North Am 13:635–648

Download references

Author information

Correspondence to Erkan Parlak.

Rights and permissions

Reprints and Permissions

About this article

Cite this article

Parlak, E., Çiçek, B., Dişibeyaz, S. et al. Endoscopic retrograde cholangiography by double balloon enteroscopy in patients with Roux-en-Y hepaticojejunostomy. Surg Endosc 24, 466–470 (2010). https://doi.org/10.1007/s00464-009-0591-3

Download citation


  • Roux-en-Y-hepaticojejunostomy
  • Pancreato bilio < cancer
  • Cholecystectomy
  • ERCP (endoscopic retrograde cholangiopancreatography)
  • Double balloon enteroscopy
  • Diagnostic and therapeutic