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ERCP using a short double-balloon enteroscope in patients with prior pancreatoduodenectomy: higher maneuverability supplied by the efferent-limb route

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Abstract

Background

In endoscopic retrograde cholangiopancreatography (ERCP) for patients who have undergone a pancreatoduodenectomy (PD) with a Braun anastomosis, two different approaches are available: the afferent-limb route and the efferent-limb route. This study was to clarify the usefulness of a short double-balloon enteroscope (DBE) in ERCP for prior-PD patients, and to reveal which route was optimal for ERCP.

Methods

Seventy-two consecutive patients with a prior PD underwent diagnostic or therapeutic ERCP using the DBE. This retrospective study evaluated the outcome of the ERCP and assessed the shape of the DBE by fluoroscopic imaging to compare the maneuverability of the two routes.

Results

In 71 patients (99 %) the bilioenteric anastomosis was reached and cholangiography was performed. Treatment was required in 59 patients (83 %) and was performed successfully in all. Complications occurred in two patients (3 %) with cholangitis. In three patients, the afferent-limb route had to be changed to the efferent-limb route in the procedure. A gentler arc-shaped angulation of the DBE was induced using the efferent-limb route compared to the afferent-limb route (128° (n = 42) vs. 113° (n = 15); p = 0.037), and that was also revealed in 11 patients (15 %) who underwent repeated ERCP by each route (123° vs. 96°; p = 0.003).

Conclusions

The short DBE facilitates ERCP in prior-PD patients. Particularly, ERCP using the efferent-limb route can achieve a maneuverable procedure without unnecessary stress, such as scope insertion to the sharp-angled afferent limb and the handling of various accessories through the narrow scope channel with a sense of resistance.

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References

  1. House MG, Cameron JL, Schulick RD, Campbell KA, Sauter PK, Coleman J, Lillemoe KD, Yeo CJ (2006) Incidence and outcome of biliary strictures after pancreaticoduodenectomy. Ann Surg 243:571–578

    Article  PubMed Central  PubMed  Google Scholar 

  2. Shimatani M, Matsushita M, Takaoka M, Koyabu M, Ikeura T, Kato K, Fukui T, Uchida K, Okazaki K (2009) Effective “short” double-balloon enteroscope for diagnostic and therapeutic ERCP in patients with altered gastrointestinal anatomy: a large case series. Endoscopy 41:849–854

    Article  CAS  PubMed  Google Scholar 

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

    Article  CAS  PubMed  Google Scholar 

  4. Itoi T, Ishii K, Sofuni A, Itokawa F, Tsuchiya T, Kurihara T, Tsuji S, Ikeuchi N, Umeda J, Moriyasu F (2010) Single-balloon enteroscopy-assisted ERCP in patients with Billroth II gastrectomy or Roux-en-Y anastomosis (with video). Am J Gastroenterol 105:93–99

    Article  PubMed  Google Scholar 

  5. Osoegawa T, Motomura Y, Akahoshi K, Higuchi N, Tanaka Y, Hisano T, Itaba S, Gibo J, Yamada M, Kubokawa M, Sumida Y, Akiho H, Ihara E, Nakamura K (2012) Improved techniques for double-balloon-enteroscopy-assisted endoscopic retrograde cholangiopancreatography. World J Gastroenterol 18:6843–6849

    Article  PubMed Central  PubMed  Google Scholar 

  6. Kimura W (2008) Strategies for the treatment of invasive ductal carcinoma of the pancreas and how to achieve zero mortality for pancreaticoduodenectomy. J Hepatobiliary Pancreat Surg 15:270–277

    Article  PubMed  Google Scholar 

  7. Feitoza AB, Baron TH (2002) Endoscopy and ERCP in the setting of previous upper GI tract surgery. Part II: postsurgical anatomy with alteration of the pancreaticobiliary tree. Gastrointest Endosc 55:75–79

    Article  PubMed  Google Scholar 

  8. Chahal P, Baron TH, Topazian MD, Petersen BT, Levy MJ, Gostout CJ (2006) Endoscopic retrograde cholangiopancreatography in post-Whipple patients. Endoscopy 38:1241–1245

    Article  CAS  PubMed  Google Scholar 

  9. Farrell J, Carr-Locke D, Garrido T, Ruymann F, Shields S, Saltzman J (2006) Endoscopic retrograde cholangiopancreatography after pancreaticoduodenectomy for benign and malignant disease: indications and technical outcomes. Endoscopy 38:1246–1249

    Article  CAS  PubMed  Google Scholar 

  10. Kikuyama M, Sasada Y, Matsuhashi T, Ota Y, Nakahodo J (2009) ERCP after Roux-en-Y reconstruction can be carried out using an oblique-viewing endoscope with an overtube. Dig Endosc 21:180–184

    Article  PubMed  Google Scholar 

  11. Nakahara K, Horaguchi J, Fujita N, Noda Y, Kobayashi G, Ito K, Obana T, Takasawa O (2009) Therapeutic endoscopic retrograde cholangiopancreatography using an anterior oblique-viewing endoscope for bile duct stones in patients with prior Billroth II gastrectomy. J Gastroenterol 44:212–217

    Article  PubMed  Google Scholar 

  12. Matsushita M, Takakuwa H, Uchida K, Nishio A, Okazaki K (2009) Techniques to facilitate ERCP with a conventional endoscope in patients with previous pancreatoduodenectomy. Endoscopy 41:902–906

    Article  CAS  PubMed  Google Scholar 

  13. Haber GB (2008) Double-balloon enteroscopy in patients with altered biliary and/or pancreatic anatomy. Gastroenterol Hepatol (N Y) 4:397–399

    Google Scholar 

  14. Cho S, Kamalaporn P, Kandel G, Kortan P, Marcon N, May G (2011) ‘Short’ double-balloon enteroscope endoscopic retrograde cholangiopancreatography in patients with a surgically altered upper gastrointestinal tract. Can J Gastroenterol 25:615–619

    PubMed Central  PubMed  Google Scholar 

  15. Trede M (1997) Technique of Whipple pancreatoduodenectomy. In: Trede M, Carter DC, Longmire WP (eds) Surgery of the Pancreas. Churchill Livingstone, New York, pp 487–498

    Google Scholar 

  16. Lin LF, Siauw CP, Ho KS, Tung JC (1999) ERCP in post-Billroth II gastrectomy patients: emphasis on technique. Am J Gastroenterol 94:144–148

    Article  CAS  PubMed  Google Scholar 

  17. Kim MH, Lee SK, Lee MH, Myung SJ, Yoo BM, Seo DW, Min YI (1997) Endoscopic retrograde cholangiopancreatography and needle-knife sphincterotomy in patients with Billroth II gastrectomy: a comparative study of the forward-viewing endoscope and the side-viewing duodenoscope. Endoscopy 29:82–85

    Article  CAS  PubMed  Google Scholar 

  18. Faylona JM, Qadir A, Chan AC, Lau JY, Chung SC (1999) Small-bowel perforations related to endoscopic retrograde cholangiopancreatography (ERCP) in patients with Billroth II gastrectomy. Endoscopy 31:546–549

    Article  CAS  PubMed  Google Scholar 

  19. Ciçek B, Parlak E, Dişibeyaz S, Koksal AS, Sahin B (2007) Endoscopic retrograde cholangiopancreatography in patients with Billroth II gastroenterostomy. J Gastroenterol Hepatol 22:1210–1213

    Article  PubMed  Google Scholar 

  20. Feitoza AB, Baron TH (2001) Endoscopy and ERCP in the setting of previous upper GI tract surgery. Part I: reconstruction without alteration of pancreaticobiliary anatomy. Gastrointest Endosc 54:743–749

    Article  CAS  PubMed  Google Scholar 

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Disclosures

Koichiro Tsutsumi, Hironari Katio, Shinichiro Muro, Naoki Yamamoto, Yasuhiro Noma, Shigeru Horiguchi, Ryo Harada, Hiroyuki Okada, and Kazuhide Yamamoto have no conflicts of interest to disclose.

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Authors and Affiliations

  1. Department of Gastroenterology and Hepatology, Graduate School of Medicine, Dentistry, and Pharmaceutical Sciences, Okayama University, 2-5-1 Shikata-cho, Kita-ku, Okayama, 700-8558, Japan

    Koichiro Tsutsumi, Hironari Kato, Shinichiro Muro, Naoki Yamamoto, Yasuhiro Noma, Shigeru Horiguchi, Ryo Harada, Hiroyuki Okada & Kazuhide Yamamoto

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  1. Koichiro Tsutsumi
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  2. Hironari Kato
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  3. Shinichiro Muro
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  4. Naoki Yamamoto
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  5. Yasuhiro Noma
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  6. Shigeru Horiguchi
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  7. Ryo Harada
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  8. Hiroyuki Okada
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  9. Kazuhide Yamamoto
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Correspondence to Koichiro Tsutsumi.

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Tsutsumi, K., Kato, H., Muro, S. et al. ERCP using a short double-balloon enteroscope in patients with prior pancreatoduodenectomy: higher maneuverability supplied by the efferent-limb route. Surg Endosc 29, 1944–1951 (2015). https://doi.org/10.1007/s00464-014-3889-8

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  • DOI: https://doi.org/10.1007/s00464-014-3889-8

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