Lars Aabakken, Oslo
Sequenzen:

If endoscopy is needed in order to reach the major duodenal papilla, you first pass the anastomosis by moving from the esophagus or residual stomach to the jejunal loop and then reach the jejunojejunostomy further down.
Due to the side-to-side anastomosis, three lumens are seen, one of which ends blindly. The duodenal loop is usually the one that goes off at the least favorable angle.
Accessing the major duodenal papilla after a Roux-en-Y reconstruction is an elaborate procedure that is usually attempted with an enteroscope. Success rates are in the range of 70–80%.