Specifics of endoscopic retrograde cholangiopancreatographyin patients with altered anatomy of gastrointestinal tract (a literature review)

The aim of the work: analysis and integration of literature data regarding the technical and methodological implementation of endoscopic retrograde cholangiopancreatography in altered anatomy of the gastrointestinal tract after gastric resection. Results. World literature data convincingly indicate the need for a staged approach to performing endoscopic retrograde cho langiopancreatography in patients with altered anatomy of the gastrointestinal tract. Scientific works state that the main stages are detailed examination of a past surgical history in patients, careful selection of suitable endoscopic instruments, afferent limb intubation, papilla of Vater cannulation and papillary interventions. The article describes the existing endoscopic instruments, modern techniques and approaches, their advantages and disadvantages, and the influence of various factors on the success of their use in comparison with traditional techniques for various types of surgical reconstruction for each of the above stages. The length of the afferent limb is one of the main factors that affect the success rates of the procedure. Conclusions. Endoscopic retrograde cholangiopancreatography in patients with altered anatomy is complex and faces a number of challenges. Thanks to the development of special instruments and techniques, it can be performed even in patients with a long Roux-en-Y limb, reaching therapeutic success rates close to those in patients with normal anatomy, but this requires extensive experience of an endoscopist. There are currently no clear recommendations for the use of a particular technique; therefore the choice of the optimal strategy depends on the type of surgical reconstruction, surgeon skill level and endoscopy center facilities.