Biliopancreatic duct approach in patients with postsurgical anatomy = Approccio alle vie biliopancreatiche nei pazienti con anatomia postchirurgica

Enteroscopic techniques, and especially double-balloon enteroscopy (DBE), has increased the ability to perform endoscopic retrograde cholangiopancreatography (ERCP) in patients with altered upper gastrointestinal anatomy, such as Roux-en-Y gastric bypass and liver transplantation, where enterobiliary anastomose strictures represent the main complications. An endoscopic approach combining DBE and ERCP (DBE-ERCP) is feasible in postsurgical anatomy, however it is a complicated technique to perform in tertiary and referral centres. Notably, novel enteroscopes dedicated to DBE-ERCP are currently available, thereby increasing the efficacy of this technique and allowing the use of standard ERCP devices. The aim of the present face-to-face interview is to provide insights and “tips and tricks” of DBE-ERCP in difficult cases of surgically altered anatomy through the description of a case.