There are few reports of ERCP in patients with long limb roux-en-Y surgical anastamoses. The majority involve accessing biliary-enteric anastamoses, with very few reports of therapeutics on intact papillas. Methods: We reviewed all our consecutive ERCP attempted in 13 pts (23 total procedures) with long-limb gastrojejunostomy and intact papilla (no previous sphincterotomy (ES), stent, or biliary-enteric anastamosis). Data were abstracted from a prospective ERCP database and chart review. Results: Indications for ERCP included suspected sphincter of Oddi dysfunction (SOD) +/- pancreatitis in 9, obstructive jaundice in 3 and chronic pancreatitis in 1. 9 pts had gastric bypass for obesity and 4 partial gastrectomy, all with roux-en-Y gastrojejunostomy. 9 pts (11 procedures) had ERCP under general anesthesia, with mean duration of 137 mins (range 50- 255mins). Procedure was initiated with colonoscope or enteroscope to find jejuno-jejunal anastamosis (usually 60 cm from gastric remnant) and ascend correct (afferent) limb to papilla (additonal 60cm), followed by wireguided exchange for a duodenoscope to perform ERCP. The duodenoscope could be advanced to the major papilla during the first procedure in 9/13 (69%); a second attempt in 1 failed. Successful bile duct cannulation and therapy was ultimately achieved in all 9 patients in whom duodenoscope insertion was successful, with cannulation on first procedure attempt (7pts), second attempt (1pt) or third attempt (1pt). Intended pancreatography was successful in 1/1 pt. Biliary ES was performed in 8/9 (needle-knife over biliary stent in 6, and needle-knife precut access papillotomy after pancreatic stenting in 2).Wallstents were placed in 2, stone extracted in 1, and SO manometry performed in 2. Final diagnosis after successful ERCP in 9 pts was suspected or confirmed SOD in 5, malignant biliary obstruction in 2, malignancy plus biliary stone in 1, and chronic pancreatitis in 1. Complications included pancreatitis in 2 (1 mild, 1 moderate) and bleed in 1 (mild), all in pts with suspected SOD. Of 4 pts with unsuccessful ERCP, 2 were sent for surgical sphincteroplasty and 2 had no further procedures. Conclusions: Diagnostic and therapeutic ERCP was ultimately successful in about 2/3 of patients with long-limb gastrojejunostomies and intact papilla, limited primarily by ability to advance any scope up afferent limb to papilla. Successful ERCP allowed therapy for problems without easy alternatives, but often required multiple and/or prolonged attempts under general anesthesia.