ERCP with Device-Assisted Enteroscopy in Patients with Altered Gastrointestinal Anatomy

Diagnosis and treatment using ERCP in patients with altered gastrointestinal anatomy have progressed greatly since the emergence of the double-balloon enteroscope in 2001. The balloon-assisted enteroscope has improved steadily over time, and a short-type balloon-assisted enteroscope with a large working channel became commercially available in 2016. These short-type balloon-assisted enteroscopes accommodate most ERCP accessories, and many kinds of ERCP intervention can be performed, such as conventional ERCP for patients with normal anatomy. Although the success rate of ERCP with balloon-assisted enteroscopy in patients with altered gastrointestinal anatomy has increased to approximately 68–98%, it is still a challenging procedure for many endoscopists. Because ERCP with a balloon-assisted enteroscope is time-consuming, mandates specialized training, and requires special endoscopes and accessories, these factors limit the widespread availability outside tertiary endoscopic referral centers. Other types of device-assisted enteroscopies, including spiral enteroscopy and through-the-scope balloon-assisted enteroscopy, have also been developed to make it easier to perform ERCP in patients with altered gastrointestinal anatomy. These novel device-assisted enteroscopy instruments are still immature compared with balloon-assisted enteroscopy for ERCP in patients with altered gastrointestinal anatomy. Therefore, both device-assisted enteroscopy and ERCP accessories must be improved for this challenging procedure to become a more general procedure.