This ASG video tip is brought to you by an educational grant from Braintree, a part of Cibela Pharmaceuticals, makers of SUTAB. Other approaches, if you can't make it work, is laparoscopically assisted. If you have a Roux-en-Y gastric bypass, particularly if that patient needs a cholecystectomy still, and they're going for a cholecystectomy laparoscopically, why not have your laparoscopic surgeon insert a 15 millimeter lap port in the OR? That's big enough to get your sterilized duodenoscope down, and you can just do a standard ERCP in the OR that way. It takes about 20 or 30 minutes of your time, if the surgeon's willing to wait to call you until they're ready for you. Your other choice is enteroscopic ERC, like I described to you, and if that's not successful, or even if it might be, you're probably statistically going to fail 50% of the time, so you could have your radiologist just insert a very small three French sheath, and through it an 018 or rather 035 long biliary guide wire, hand that off to them, and they'll send the patient over to you with that wire in. You use that wire, you capture it with a snare, bring it up through your enteroscope or your colonoscope, and then when you're done with your ERCP, you've done your sphincterotomy and removed the stone, or you've placed a stent, all you have is a wire puncture there, so you can easily remove that wire, put a band-aid on it, and send the patient home. We actually do that fairly frequently. There's also EUS guided biliary access and drainage procedures, and Ashley, whose expertise is exactly that, is going to show you some of that. Thank you very much.

cholecystectomy

laparoscopic surgeon

ERCP

enteroscopic ERC

EUS guided biliary access