Spiral enteroscopy for therapeutic ERCP in patients with surgically altered anatomy: actual technique and review of the literature

Endoscopic retrograde cholangiopancreatography (ERCP) and associated procedures are difficult to perform in patients with surgically altered anatomy. Recently, balloon enteroscopy (BE) has made it easier to perform ERCP in these patients. However, BE-assisted ERCP is often technically demanding and time consuming. Spiral enteroscopy (SE), which has recently been developed, is a novel method of using a rotating overtube to pleat small bowel onto the enteroscope, thus advancing it through the lumen. We review the mechanism and efficacy of SE, especially in ERCP of patients with surgically altered anatomy, and report on the first patient to undergo ERCP using SE in Japan. Spiral enteroscopy-assisted ERCP seems to be feasible and safe in patients with surgically altered anatomy. Additionally, SE-assisted ERCP appears to be easier to perform than other methods previously described and allows stable positioning of the enteroscope in order to perform delicate therapeutic maneuvers. SE for ERCP is expected to be at least as useful as balloon enteroscopy in patients with surgically altered anatomy.