An enteroscopic method that uses a pediatric colonoscope provides an alternative approach to the diagnostic and management problems arising in the setting of a Roux-en-Y limb hepaticojejunostomy or biliary diversion. Three patients with Roux-en-Y limb reconstructions who experienced recurrent cholangitis, recurrent pancreatitis, or choledocholithiasis in whom the technique was used are presented. The technique, which uses colonoscopic principles, is discussed along with the combined use of percutaneous transhepatic assistance. Enteroscopy of a Roux-en-Y limb is technically feasible and expands the diagnostic and management approach to biliary and pancreatic disease involving this postoperative anatomic condition.
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