Fig. 4.

( a ) Fluoroscopic images during endoscopic retrograde cholangiopancreatography (ERCP) in a 58-year-old man following Roux-en-Y hepaticojejunostomy demonstrates markedly redundant pediatric colonoscope (arrow) is passed deep into the jejunum to reach the choledochostomy. Contrast is injected through the percutaneous biliary drain (arrowhead) prior to biliary cannulation which allows the endoscopist to estimate the amount of liver being drained. ( b ) A 7-Fr plastic biliary stent (arrows) is deployed into a segment of the left liver lobe. The percutaneous biliary drain (arrowhead) is capped for 2 weeks as a trial prior to drain removal. Performing ERCP in patients with surgically altered anatomy is technically demanding due to the increased length of bowel that must be traversed and the use of nonstandard or individually modified equipment.