They concluded that inexpert endoscopists should attempt using forward-viewing gastroscopes first and then start using duodenoscopes as they would have gained experience in ERCP for patients with an altered anatomy. They also reported that the rate of afferent loop perforation by the inexpert endoscopist (6.25%) was higher than that of the expert endoscopist (0%, p=0.053). reported that the mean procedure time of an expert endoscopist with a side-view duodenoscope (23.8 min) was significantly shorter than that of an inexpert endoscopist (40.68 min, p<0.001) in patients with a Billroth II gastrectomy. The Billroth II gastrectomy is one of the most common surgical techniques for the treatment of peptic ulcers and gastric cancer. SBEs and DBEs have enough length and balloons to overcome long-limb reconstructions, angulations, and adhesion deformities in patients with RTG with REY and PPPD. Recently, enteroscope-guided ERCP with a single-balloon enteroscope (SBE) and a double-balloon enteroscope (DBE) have been most commonly used to overcome this struggle in patients with RTG with REY and PPPD. However, it is difficult to accomplish effective intubation with a side-view duodenoscope in patients with a radical total gastrectomy with Roux-en-Y anastomosis (RTG with REY) and a pylorus-preserving pancreaticoduodenectomy (PPPD). In patients with Billroth I anastomosis, a side-view duodenoscope is a very useful tool for effective intubation and therapeutic procedures in ERCP. The most common difficulty of ERCP may be in reaching the ampulla of Vater (AOV) or a hepaticojejunostomy site in SAAs. Endoscopic retrograde cholangiopancreatography (ERCP) is stimulating for endoscopists, including experts in different surgically altered anatomies (SAAs), since there are many complex variations in surgical techniques.
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