NEW UNDERWATER CAP-ASSISTED TECHNIQUE FOR ENDOSCOPIC RETROGRADE CHOLANGIOPANCREATOGRAPHY (ERCP) IN A PATIENT WITH SURGICALLY ALTERED ANATOMY

Background ERCP-rate in surgically-altered-anatomy (SAA) patients has increased. Given the difficulty to reach the papilla/the complicated angulation, treating SAA-patients is challenging. The used approaches are transmural-accesses (EUS-guided) and transluminal-access (enteroscope-mediated). ERCP-success-rate in SAA patients is low.

Methods: A 76 y.o. man with previous partial-gastrectomy with Roux-en-Yreconstruction,complained epigastric-burning-pain. At the cholangio-MRI:intra/extra-hepatic bile-ducts dilation with a biliary-duct-stone.

Results ERCP was performed with a 160 cm-pediatric (CAP-assisted) colonoscope (11.5 mm,3.2 mm) using the underwater-technique to overcome the structural-abnormalities.

Conclusions: Thanks to the underwater-technique we intubated an insidious surgically-altered-anatomy, reducing the friction of the intestinal-walls despite length/angles. The colonoscope allowed us to use ERCP-standard-devices and eased papilla-cannulation despite its orientation, thanks to the frontal-view. The use of a CAP-assisted-pediatric-colonoscope with the underwater-technique should be considered as a promising approach that allows an easier/faster procedure.