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Single Balloon Enteroscopy (SBE) Assisted Therapeutic Endoscopic Retrograde Cholangiopancreatography (ERCP) in Patients with Roux-en-Y Anastomosis

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Abstract

Background

Endoscopic retrograde cholangiopancreatography (ERCP) in patients with Roux-en-Y anastomosis is a complex challenge. Long length of afferent limb after an acute angle at the jejunojejunostomy and altered location of the biliary orifice make biliary cannulation difficult. Single balloon enteroscopy assisted ERCP (SBE-ERCP) is a promising alternative to conventional approaches.

Aim

The purpose of this study was to assess the efficacy and safety of SBE-ERCP in patients with Roux-en-Y reconstruction at a high volume tertiary referral center.

Methods

This is a retrospective cohort study. All procedures were performed by a single, experienced pancreatobiliary endoscopist. Patient demographics and related clinical data were obtained. The rate of procedure successes and complications were determined.

Results

Fourteen patients (nine women) with a median age of 63 years (range 35–83 years) underwent 22 SBE-ERCP procedures from March 2009 to May 2011. Surgically altered anatomy consisted of Whipple procedure (n = 4), hepaticojejunostomy (n = 9) and partial gastrectomy (n = 1). Indications for SBE-ERCP were obstructive jaundice (n = 10), cholangitis (n = 7), post-PTC internalization (n = 3) and biliary stent extraction/exchange (n = 2). The hepaticojejunostomy site (HJS) was reached in 15 (68 %) procedures. Successful interventions were performed in 11 (73 %) of 15 cases, including balloon dilation of biliary strictures (n = 3), insertion of biliary stents (n = 7), retrieval of biliopancreatic stents (n = 4) and biliary stone extraction (n = 4). The mean procedural time for successful interventions was 97.6 min (range 73–147 min). No procedural complications occurred during the median follow-up of 501 days (range 22–1,242 days).

Conclusion

SBE-ERCP is safe and carries an acceptable success rate in experienced hands.

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References

  1. Suissa A, Yassin K, Lavy A, et al. Outcome and early complications of ERCP: a prospective single center study. Hepatogastroenterology. 2005;52:352–355.

    CAS  PubMed  Google Scholar 

  2. Emmett DS, Mallat DB. Double-balloon ERCP in patients who have undergone Roux-en-Y surgery: a case series. Gastrointest Endosc. 2007;66:1038–1041.

    Article  PubMed  Google Scholar 

  3. Aabakken L, Bretthauer M, Line PD. Double-balloon enteroscopy for endoscopic retrograde cholangiography in patients with a Roux-en-Y anastomosis. Endoscopy. 2007;39:1068–1071.

    Article  CAS  PubMed  Google Scholar 

  4. Mönkemüller K, Bellutti M, Neumann H, et al. Therapeutic ERCP with the double-balloon enteroscope in patients with Roux-en-Y anastomosis. Gastrointest Endosc. 2008;67:992–996.

    Article  PubMed  Google Scholar 

  5. Koornstra JJ. Double balloon enteroscopy for endoscopic retrograde cholangiopancreaticography after Roux-en-Y reconstruction: case series and review of the literature. Neth J Med. 2008;66:275–279.

    CAS  PubMed  Google Scholar 

  6. Moreels TG, Hubens GJ, Ysebaert DK, et al. Diagnostic and therapeutic double-balloon enteroscopy after small bowel Roux-en-Y reconstructive surgery. Digestion. 2009;80:141–147.

    Article  PubMed  Google Scholar 

  7. Parlak E, Ciçek B, Dişibeyaz S, et al. Endoscopic retrograde cholangiography by double balloon enteroscopy in patients with Roux-en-Y hepaticojejunostomy. Surg Endosc. 2010;24:466–470.

    Article  PubMed  Google Scholar 

  8. Raithel M, Dormann H, Naegel A, et al. Double-balloon-enteroscopy-based endoscopic retrograde cholangiopancreatography in post-surgical patients. World J Gastroenterol. 2011;17:2302–2314.

    Article  PubMed  Google Scholar 

  9. Koornstra JJ, Fry L, Mönkemüller K. ERCP with the balloon-assisted enteroscopy technique: a systematic review. Dig Dis. 2008;26:324–329.

    Article  PubMed  Google Scholar 

  10. Neumann H, Fry LC, Meyer F, et al. Endoscopic retrograde cholangiopancreatography using the single balloon enteroscope technique in patients with Roux-en-Y anastomosis. Digestion. 2009;80:52–57.

    Article  PubMed  Google Scholar 

  11. ASGE Technology Committee. Overtube use in gastrointestinal endoscopy. Gastrointest Endosc. 2009;70:828–834.

    Article  Google Scholar 

  12. Rossos PG, Kortan P, Haber G. Selective common bile duct cannulation can be simplified by the use of a standard papillotome. Gastrointest Endosc. 1993;39:67–69.

    Article  CAS  PubMed  Google Scholar 

  13. Cotton PB, Lehman G, Vennes J, et al. Endoscopic sphincterotomy complications and their management: an attempt at consensus. Gastrointest Endosc. 1991;37:383–393.

    Article  CAS  PubMed  Google Scholar 

  14. Gostout CJ, Bender CE. Cholangiopancreatography, sphincterotomy, and common duct stone removal via Roux-en-Y limb enteroscopy. Gastroenterology. 1988;95:156–163.

    CAS  PubMed  Google Scholar 

  15. Elton E, Hanson BL, Qaseem T, et al. Diagnostic and therapeutic ERCP using an enteroscope and a pediatric colonoscope in long-limb surgical bypass patients. Gastrointest Endosc. 1998;47:62–67.

    Article  CAS  PubMed  Google Scholar 

  16. Wright BE, Cass OW, Freeman ML. ERCP in patients with long-limb Roux-en-Y gastrojejunostomy and intact papilla. Gastrointest Endosc. 2002;56:225–232.

    Article  PubMed  Google Scholar 

  17. Mönkemüller K, Fry LC, Bellutti M, et al. ERCP using single-balloon instead of double-balloon enteroscopy in patients with Roux-en-Y anastomosis. Endoscopy. 2008;40:E19–E20.

    Article  PubMed  Google Scholar 

  18. Dellon ES, Kohn GP, Morgan DR, et al. Endoscopic retrograde cholangiopancreatography with single-balloon enteroscopy is feasible in patients with a prior Roux-en-Y anastomosis. Dig Dis Sci. 2009;54:1798–1803.

    Article  PubMed  Google Scholar 

  19. Itoi T, Ishii K, Sofuni A, et al. Single-balloon enteroscopy-assisted ERCP in patients with Billroth II gastrectomy or Roux-en-Y anastomosis. Am J Gastroenterol. 2010;105:93–99.

    Article  PubMed  Google Scholar 

  20. Wang AY, Sauer BG, Behm BW, et al. Single-balloon enteroscopy effectively enables diagnostic and therapeutic retrograde cholangiography in patients with surgically altered anatomy. Gastrointest Endosc. 2010;71:641–649.

    Article  PubMed  Google Scholar 

  21. Saleem A, Baron TH, Gostout CJ, et al. Endoscopic retrograde cholangiopancreatography using a single-balloon enteroscope in patients with altered Roux-en-Y anatomy. Endoscopy. 2010;42:656–660.

    Article  CAS  PubMed  Google Scholar 

  22. Tsujikawa T, Saitoh Y, Andoh A, et al. Novel single-balloon enteroscopy for diagnosis and treatment of the small intestine: preliminary experiences. Endoscopy. 2008;40:11–15.

    Article  CAS  PubMed  Google Scholar 

  23. Moreels TG, Pelckmans PA. Comparison between double-balloon and single-balloon enteroscopy in therapeutic ERC after Roux-en-Y entero-enteric anastomosis. World J Gastrointest Endosc. 2010;2:314–317.

    Article  PubMed Central  PubMed  Google Scholar 

  24. Lennon AM, Kapoor S, Khashab M, et al. Spiral assisted ERCP is equivalent to single balloon assisted ERCP in patients with Roux-en-Y anatomy. Dig Dis Sci. 2012;57:1391–1398.

    Article  PubMed  Google Scholar 

  25. Kogure H, Watabe H, Yamada A, et al. Spiral enteroscopy for therapeutic ERCP in patients with surgically altered anatomy: actual technique and review of the literature. J Hepatobiliary Pancreat Sci. 2011;18:375–379.

    Article  PubMed  Google Scholar 

  26. Saleem A, Levy MJ, Petersen BT, et al. Laparoscopic assisted ERCP in Roux-en-Y gastric bypass (RYGB) surgery patients. J Gastrointest Surg. 2012;16:203–208.

    Article  PubMed  Google Scholar 

  27. Schreiner MA, Chang L, Gluck M, et al. Laparoscopy-assisted versus balloon enteroscopy-assisted ERCP in bariatric post-Roux-en-Y gastric bypass patients. Gastrointest Endosc. 2012;75:748–756.

    Article  PubMed  Google Scholar 

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Correspondence to Andres Gelrud.

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Tomizawa, Y., Sullivan, C.T. & Gelrud, A. Single Balloon Enteroscopy (SBE) Assisted Therapeutic Endoscopic Retrograde Cholangiopancreatography (ERCP) in Patients with Roux-en-Y Anastomosis. Dig Dis Sci 59, 465–470 (2014). https://doi.org/10.1007/s10620-013-2916-2

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  • DOI: https://doi.org/10.1007/s10620-013-2916-2

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