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Post-Surgical Anatomy Procedures


Procedure Details

Enteroscopy-assisted ERCP (DBE-assisted ERCP)
  • In patients with Roux-en-Y gastric bypass, Billroth II anatomy, hepaticojunostomy and post-Whipple anatomy, the bile duct anastomosis (connection) can be reached using a specialized double-balloon enteroscope in order to perform ERCP.
  • These procedures are extremely technical and require a very high level of expertise. Navigating the small bowel is challenging due to its small diameter and length and in post-surgical patients there is the added challenge of re-routed anatomy .
  • Double-balloon enteroscopes, appropriate accessories and adequately trained support staff in addition to highly skilled endoscopists are required to perform these procedures successfully.
EDGE –EUS-Directed Transgastric ERCP
  • This new endoscopic intervention is designed to allow endoscopic access to the excluded stomach and duodenum in patients with Roux-en-Y Gastric Bypass. Due to its complexity and risk, this procedure is only performed by a handful of experts in Advanced Endoscopy in the country.
  • The 1st step utilizes Endoscopic Ultrasound (EUS) to place a special metal stent between the gastric pouch and excluded part of the stomach bridging these two structures.
  • During the 2nd step, usually performed a few days or weeks later, the standard ERCP scope can be advanced into the duodenum through the recently placed stent allowing patients to have a high quality ERCP.
  • The metal stent used to create the bridge between the gastric pouch and excluded stomach is then removed in 3rd step of the procedure.
EUS-guided Enteroscopy-assisted ERP
  • This is an original technique that was developed by Dr. Pitea which allows access to the pancreatic duct in patients with complete blockage of the pancreatic duct anastomosis following Whipple surgery.
  • An enteroscope is initially used to reach the pancreaticojejunal anastomosis. An EUS miniprobe is then advanced through the enteroscope and used to identify the dilated pancreatic duct.
  • The thick scar tissue at the level of pancreaticojejunostomy is then dissected with a needle knife allowing for wire access into the pancreatic duct and subsequent stent placement
  • This is a very complex intervention that requires a very high level of expertise in Advanced Endoscopy.

Benefits of Endoscopy

 Allow patients to avoid invasive surgery

 Most procedures are done in Outpatient Endoscopy Units

 Patients can resume near normal activity within the same day

 High safety profile

Why Choose IEA

 Drs. Pitea and Mounzer have extensive expertise in the endoscopic management of patients with post-surgical anatomy.

 Dr. Pitea has published an Original Technique on EUS mini probe guided enteroscopy assisted ERP for patients with complete pancreatic-jejunostomy stenosis after Whipple surgery, the abstract was accepted for an oral presentation at DDW (Digestive Disease Week) in 2018.

 Please refer to Research Page for more information regarding our research.

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