Technique | Advantages | Disadvantages | Best application |
Duodenoscope advanced transorally through anatomic route |
| Frequently unsuccessful due to inability to reach target | Patients with short Roux limb and native papilla |
Colonoscope/enteroscope advanced transorally through anatomic route |
|
| Patients with short Roux limb and bilioenteric/ pancreatoenteric anastomosis |
Deep enteroscopy assisted ERCP | Greater reliability in reaching target, even in patients with long Roux limb |
| Patients with long Roux limb and bilioenteric/ pancreatoenteric anastomosis |
Transgastrostomy tract ERCP |
| More invasive than purely endoscopic techniques | RYGB patients with native papilla, or when repeated procedures are anticipated |
Laparoscopy-assisted ERCP |
|
| RYGB patients with native papilla, particularly when internal hernia is suspected |
Percutaneous approaches via interventional radiology | Less invasive than surgical approaches |
| Patients with biliary tract pathology who are poor surgical candidates |
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