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Outcomes of endoscopic treatment for malignant biliary obstruction in patients with surgically altered anatomy: analysis of risk factors for clinical failure

  • Takeshi TomodaEmail author
  • Hironari Kato
  • Kazuya Miyamoto
  • Akihiro Matsumi
  • Eijiro Ueta
  • Yuuki Fujii
  • Yousuke Saragai
  • Tatsuhiro Yamazaki
  • Daisuke Uchida
  • Kazuyuki Matsumoto
  • Shigeru Horiguchi
  • Koichiro Tsutsumi
  • Hiroyuki Okada
Article
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Abstract

Background

To evaluate the outcomes of endoscopic retrograde cholangiopancreatography (ERCP) for malignant biliary obstruction (MBO) using short-type double-balloon enteroscope (sDBE) in patients with surgically altered anatomy.

Methods

A total of 45 patients with surgically altered anatomy underwent ERCP using sDBE for the treatment of MBO between April 2011 and March 2019. We retrospectively evaluated the clinical and technical success (insertion and biliary intervention success), adverse events, and risk factors for clinical failure.

Results

The scope was successfully inserted in the target site in 82.2% of patients (37/45), and among them, biliary intervention success was achieved in 86.4% (32/37). The overall technical success rate was 71.1% (32/45) and clinical success rate was 68.9% (31/45), with an adverse event rate of 11.1%. In multivariate analysis, the presence of peritoneal dissemination (odds ratio, 7.3; 95% confidence interval, 1.5–43.5, p = 0.02) was as an independent risk factor for clinical failure. The clinical success rate was 38.5% in patients with peritoneal dissemination and 81.3% in those without peritoneal dissemination.

Conclusion

Endoscopic treatment using sDBE in patients without peritoneal dissemination provided favorable outcomes, and it can be an initial treatment for MBO in patients with surgically altered anatomy.

Keywords

Malignant biliary obstruction Double-balloon enteroscope Endoscopic retrograde cholangiopancreatography Surgically altered anatomy 

Notes

Compliance with ethical standards

Disclosures

Takeshi Tomoda, Hironari Kato, Kazuya Miyamoto, Akihiro Matsumi, Eijiro Ueta, Yuuki Fujii, Yousuke Saragai, Tatsuhiro Yamazaki, Daisuke Uchida, Kazuyuki Matsumoto, Shigeru Horiguchi, Koichiro Tsutsumi, and Hiroyuki Okada have no conflicts of interest or financial ties to disclose.

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Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature 2020

Authors and Affiliations

  • Takeshi Tomoda
    • 1
    Email author
  • Hironari Kato
    • 1
  • Kazuya Miyamoto
    • 1
  • Akihiro Matsumi
    • 1
  • Eijiro Ueta
    • 1
  • Yuuki Fujii
    • 1
  • Yousuke Saragai
    • 1
  • Tatsuhiro Yamazaki
    • 1
  • Daisuke Uchida
    • 1
  • Kazuyuki Matsumoto
    • 1
  • Shigeru Horiguchi
    • 1
  • Koichiro Tsutsumi
    • 1
  • Hiroyuki Okada
    • 1
  1. 1.Department of Gastroenterology and HepatologyOkayama University HospitalOkayama-city, OkayamaJapan

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