Evaluation of complications after endoscopic retrograde cholangiopancreatography using a short type double balloon endoscope in patients with altered gastrointestinal anatomy: a single‐center retrospective study of 1, 576 procedures. Issue 8 (5th April 2020) - Tokuhara, Mitsuo
Abstract: Background and Aim: Endoscopic retrograde cholangiopancreatography (ERCP) using balloon‐assisted endoscope such as double‐balloon endoscope is even effective for patients with surgically altered anatomy. Yet comprehensive studies on complications of ERCP using balloon‐assisted endoscope have not been made. We analyzed the characteristics and the causes of complications of ERCP using double‐balloon endoscope (DB‐ERCP) procedures and aimed to suggest effective managements. Methods: A total of 1576 procedures of DB‐ERCP in 714 patients with surgically altered gastrointestinal anatomy in our hospital were evaluated retrospectively using a statistic analysis. Results: The overall complication occurrence rate was 5.8%. By type of complications are perforation 3.2%, mucosal laceration 0.5%, hemorrhage 1.0%, pancreatitis 0.6%, respiratory disorder 0.4%, and others 0.2%. By type of surgical reconstruction methods were Roux‐en‐Y reconstruction with choledocho‐jejunal anastomosis 4.2%, Roux‐en‐Y reconstruction without choledocho‐jejunal anastomosis 6.7%, pancreaticoduodenectomy 4.5%, pylorus preserving pancreaticoduodenectomy 4.2%, Billroth II gastrectomy (B‐II) 11.6%, and other reconstruction method (others) 7.4%. The contributing factors calculated by a multivariate analysis were B‐II (odds ratio: 1.864, 95% confidence interval: 1.001–3.471, P = 0.050) and the presence of naïve papilla (odds ratio: 3.268, 95% confidence interval: 1.426–7.490, P = 0.005). Conclusions: DB‐ERCP is a safe method with a total complication rate of 5.8% that could be considered within an acceptable range. The most common complication was the injury of the digestive tract such as perforation. Affecting risk factors for complications were B‐II and the presence of naïve papilla. DB‐ERCP procedures should be performed carefully of these factors.