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Potential Factors Affecting Results of Short-Type Double-Balloon Endoscope-Assisted Endoscopic Retrograde Cholangiopancreatography

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Abstract

Background

Short-type double-balloon endoscope (DBE)-assisted endoscopic retrograde cholangiopancreatography (ERCP) has been developed as an alternative approach for cases with a surgically altered gastrointestinal anatomy. However, this technique is sometimes technically challenging and carries a risk of severe adverse events.

Aims

To evaluate the factors affecting the technical success rate and adverse events of DBE-ERCP.

Methods

A total of 319 patients (805 procedures) with a surgically altered gastrointestinal anatomy underwent short DBE-ERCP. The factors affecting the technical success rate and adverse events, and the learning curve of the trainees were retrospectively evaluated.

Results

The technical success rate of all procedures was 90.7%. Adverse events occurred in 44 (5.5%) procedures. A multivariate analysis indicated that Roux-en-Y reconstruction and first-time short DBE-ERCP were factors affecting the technical failure and adverse event rates, while the modified Child method after subtotal stomach-preserving pancreaticoduodenectomy reconstruction was a non-risk factor for adverse events. The trainee caseload did not affect the technical success or adverse event rates significantly; however, trainees tended to perform cases involving the modified Child method after subtotal stomach-preserving pancreaticoduodenectomy reconstruction. The success rate of scope insertion increased according to experience; however, the overall success rate did not differ to a statistically significant extent.

Conclusion

Short DBE-ERCP was useful and safe for managing cases with a surgically altered anatomy; however, trainees should concentrate on accumulating experience with easy cases, such as those with the modified Child method after subtotal stomach-preserving pancreaticoduodenectomy reconstruction or a history of DBE-ERCP.

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Authors and Affiliations

  1. Department of Gastroenterology, Okayama University Hospital, 2-5-1 Shikata-cho, Kita-ku, Okayama, 700-8558, Japan

    Daisuke Uchida, Koichiro Tsutsumi, Hironari Kato, Akihiro Matsumi, Yosuke Saragai, Takeshi Tomoda, Kazuyuki Matsumoto & Hiroyuki Okada

  2. Center for Innovative Clinical Medicine, Okayama University Hospital, Okayama, Japan

    Daisuke Uchida

  3. Department of General Medicine, Okayama University Hospital, Okayama, Japan

    Shigeru Horiguchi

Authors
  1. Daisuke Uchida
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  2. Koichiro Tsutsumi
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  3. Hironari Kato
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  4. Akihiro Matsumi
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  6. Takeshi Tomoda
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  7. Kazuyuki Matsumoto
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  8. Shigeru Horiguchi
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  9. Hiroyuki Okada
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Correspondence to Daisuke Uchida.

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Uchida, D., Tsutsumi, K., Kato, H. et al. Potential Factors Affecting Results of Short-Type Double-Balloon Endoscope-Assisted Endoscopic Retrograde Cholangiopancreatography. Dig Dis Sci 65, 1460–1470 (2020). https://doi.org/10.1007/s10620-019-05857-3

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  • DOI: https://doi.org/10.1007/s10620-019-05857-3

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