Figure 6.

Roux-en-Y jejunojejunal anastomosis. (a) The afferent limb is on the right. (b) The afferent limb is on the left. In both cases there were bile induced bubbles at the entrance of the limb. However, these bubbles are nonspecific. (c) It is recommended to use an India ink tattoo to mark the afferent limb. However, when the scope has advanced deeply into the efferent limb it is fine to mark the proximal end of this limb. The main objective is to have one limb clearly marked, but the report should clearly specify which one is marked. Marking the efferent limb may be easier and more practical, as the entrance to the afferent limb may be ‘upward’ and angulated. During repeat balloon-overtube-assisted enteroscopy for endoscopic retrograde cholangiopancreatography the upwards going limb with its India ink tattoo may be missed.