Advantages of the dual-channel multi-bending endoscope for ERCP in patients with Billroth II reconstruction.

Endoscopic retrograde cholangiopancreatography (ERCP) is challenging in patients with surgically altered anatomy; in these cases, balloon-enteroscope-assisted ERCP can be performed [1] [2] [3]. In patients who have undergone distal gastrectomy with Billroth II reconstruction, the duodenal papilla is within the range of a normal endoscope. The dual-channel multi-bending scope (M-scope – GIF-2TQ260M; Olympus Corp., Tokyo, Japan) ([Fig. 1]) has reported efficacy for ERCP in these patients [4]; however, precise techniques and methodologies are lacking. Herein, we describe the advantages of using the M-scope in patients with Billroth II anatomy ([Video 1]).