Single‐ and double‐balloon enteroscopy‐assisted endoscopic retrograde cholangiopancreatography in patients with Roux‐en‐Y plus hepaticojejunostomy anastomosis and Whipple resection. (April 2014)

• Record Type: Journal Article
• Authors: Itokawa, Fumihide; Itoi, Takao; Ishii, Kentaro; Sofuni, Atsushi; Moriyasu, Fuminori
• Is Part Of: Digestive endoscopy. Volume 26(2014)Supplement 2
• Page Start: 136
• Page End: 143
• Publication Date: 2014-04
• Subjects: balloon‐assisted enteroscopy -- endoscopic retrograde cholangiopancreatography (ERCP) -- hepaticojejunostomy -- Roux‐en‐Y -- single‐balloon enteroscopy; Digestive organs -- Diseases -- Periodicals; Digestive organs -- Diseases -- Diagnosis -- Periodicals; Endoscopy -- Periodicals; Digestive System Diseases -- diagnosis -- Periodicals; Digestive System Diseases -- therapy -- Periodicals; Endoscopy -- Periodicals; 616.3
• DOI: 10.1111/den.12254
• Languages: English
• ISSNs: 0915-5635

Abstract

Abstract : Background and Aim: In patients with Roux‐en‐Y hepaticojejunostomy (HJ with R‐Y) and Whipple resection, endoscopic retrograde cholangiopancreatography (ERCP) can be challenging. We report our experience with ERCP using balloon‐assisted enteroscopy (BAE) (BAE‐ERCP) in patients with HJ with R‐Y, and Whipple resection. Methods: BAE‐ERCP procedures were carried out in 62 patients (HJ with R‐Y : Whipple resection = 34:28). Results: Overall, the rates of reaching the anastomosis were 85.3% (29/34) in HJ with R‐Y and 96.4% (27/28) in Whipple resection. In terms of HJ with R‐Y, insertion success rate by standard single‐balloon enteroscopy (SBE) was 89.3% (25/28). Insertion success rate by short BAE, including SBE and double‐balloon enteroscopy (DBE), was 50% (3/6). There was a statistically significant difference of insertion success rate between standard long BE and short BE ( P = 0.021). However, in the Whipple patients, insertion success rate by standard and short SBE was 93.8% (15/16) and 91.7% (11/12), respectively. Initial insertion success rate by short BAE in Whipple patients was significantly higher than in HJ with R‐Y (91.7% vs 50%, P = 0.045). Therapeutic interventions included dilation of anastomosis stricture, stone extraction, endoscopic mechanical lithotripsy, biliary stent placement, stent extraction, endoscopic nasobiliary drainage, direct cholangioscopy, and electrohydraulic lithotripsy. Our HJ with R‐Y series and Whipple series treatment success rate was 90% (18/20) and 95.0% (19/20), respectively. Conclusions: BAE‐ERCP enabled ERCP to be carried out in patients with HJ. It is considered safe and feasible. Further experience and device improvement are needed.