ERCP in patients with Roux-en-Y anatomy

Approach to ERCP in patients with Roux-en-Y anatomy. Panel A shows the laparoscopic-assisted, transgastric approach with the trocar seen entering the stomach. Gastric access can be achieved through multiple methods; see the UpToDate topic "ERCP in patients with Roux-en-Y anatomy" for details. Panel B shows the transoral endoscopic approach.