Post Gastrojejunostomy Endoscopic Retrograde Cholangiopancreatography: Case Series and Review of Literature

Anand Bhandary Panambur ¹* and Anand Ignatius Peter ²

¹Assistant Professor, Department of General Surgery, A.J. Institute of Medical Sciences and Research Center, Mangalore., India
²Professor, Department of General Surgery, A.J. Institute of Medical Sciences and Research Center, Mangalore., India

*Corresponding Author: Anand Bhandary Panambur, Assistant Professor, Department of General Surgery, A.J. Institute of Medical Sciences and Research Center, Mangalore., India.

Received: October 14, 2025; Published: October 30, 2025

Abstract

Objective: Endoscopic retrograde cholangiopancreatography (ERCP) is a well-established modality for the management of pancreaticobiliary disorders, boasting a success rate of approximately 90–95% in patients with native pancreaticoduodenal anatomy. However, ERCP becomes considerably more challenging in patients with surgically altered gastroduodenal anatomy, particularly following bypass procedures for distal gastric pathology. Such cases necessitate the involvement of highly trained and experienced endoscopists or surgeons due to the technical complexities involved.

Case Presentation: We present a series of four cases in which therapeutic ERCP was performed in patients with a history of gastrojejunostomy after surgical intervention for distal gastric pathology. The major procedural challenges encountered included identification and intubation of the afferent limb, navigation to the papilla, successful cannulation of the papilla and common bile duct, and execution of the appropriate therapeutic interventions.

Discussion: This case series highlights the unique difficulties associated with ERCP in patients with surgically altered anatomy. Strategies to overcome these challenges and optimize clinical outcomes are discussed, and our experience is contextualized through a review of the available literature on this topic.

Conclusion: Therapeutic ERCP in patients with gastrojejunostomy following distal gastric surgery is technically demanding but feasible in experienced hands. Careful preprocedural planning and advanced endoscopic techniques are critical for achieving successful outcomes in this complex patient population.

Keywords: ERCP; Endoscopic Retrograde Cholangiopancreatography; Therapeutic ERCP; Surgically Altered Biliary Anatomy; Gastrojejunostomy; Afferent Limb Cannulation

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Citation

Citation: Anand Bhandary Panambur and Anand Ignatius Peter. “Post Gastrojejunostomy Endoscopic Retrograde Cholangiopancreatography: Case Series and Review of Literature". Acta Scientific Clinical Case Reports 6.10 (2025): 30-34.

Copyright

Copyright: © 2025 Anand Bhandary Panambur and Anand Ignatius Peter. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.