Underwater cap-assisted Endoscopic Retrograde Cholangiopancreatography in patients with surgically altered anatomy: a pilot study

Introduction Endoscopic retrograde cholangiopancreatography (ERCP) in surgically altered anatomy (SAA) pa-tients is technically challenging and associated with a significant number of failures. We examined the feasibility and efficacy of a novel technique for management of jaundice orcholangitis second-ary to bile duct stones (BDS), called underwater cap-assisted ERCP (u-ERCP). Methods Between June 2019 and February 2020 all patients with jaundice or cholangitis secondary to bile duct stones (BDS) with SAA who underwent u-ERCP were enrolled. The u-ERCP tecnnique combines the underwater advancement of a pediatric colonoscope with a transparent cap fitted on the tip of the endoscope. We evaluated the technical success, clinical suc-cess and adverse events associated with u-ERCP. Results We describe the technique itself and our first experience in 6 patients. A complete and successful procedure was carried out in all patients with no adverse events occurrence. None of the patients needed additional treatments for recurrence of symptoms during the follow-up period. Conclusions The u-ERCP can be considered as a promising alternative for successful endoscopic management of biliary disease in patients with SAA.