Skip to main content

Advertisement

SpringerLink
Log in

Endoscopic Retrograde Cholangiopancreatography with Single-Balloon Enteroscopy Is Feasible in Patients with a Prior Roux-en-Y Anastomosis

  • Original Article
  • Published:
Digestive Diseases and Sciences Aims and scope Submit manuscript

Abstract

The purpose of this study is to describe the feasibility of using single-balloon enteroscopy (SBE) to perform endoscopic retrograde cholangiopancreatography (ERCP) in patients who had a prior Roux-en-Y (RY) anastomosis. This case series describes four patients, one with RY gastric bypass, two with RY due to bile duct injury, and one with RY after liver transplantation, who underwent ERCP with SBE. Cholangiography was successful in three of the four patients. In the procedure that was not successful, the enteroenterostomy site could not be located. The successful procedures ranged from 65–91 min in duration. Medication doses were higher than with typical ERCPs. No procedural complications occurred. SBE for ERCP is a feasible option for endoscopic access to the biliary tree in patients with prior RY anastomoses. Limitations of this technique include the time requirement, delay in identification of the enteroenterostomy site, potential learning curve, and immature technology lacking accessories.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3

Similar content being viewed by others

Abbreviations

SBE:

Single-balloon enteroscopy

ERCP:

Endoscopic retrograde pancreatography

RY:

Roux-en-Y

MRCP:

Magnetic resonance cholangiopancreatography

PSC:

Primary sclerosing cholangitis

PTC:

Percutaneous transhepatic cholangiography

DBE:

Double-balloon enteroscopy

References

  1. 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. doi:10.1016/S0016-5107(02)70182-X.

    Article  PubMed  Google Scholar 

  2. Hintze RE, Adler A, Veltzke W, Abou-Rebyeh H. Endoscopic access to the papilla of Vater for endoscopic retrograde cholangiopancreatography in patients with billroth II or Roux-en-Y gastrojejunostomy. Endoscopy. 1997;29:69–73.

    Article  PubMed  CAS  Google Scholar 

  3. Verdonk RC, Buis CI, Porte RJ, et al. Anastomotic biliary strictures after liver transplantation: causes and consequences. Liver Transpl. 2006;12:726–735. doi:10.1002/lt.20714.

    Article  PubMed  Google Scholar 

  4. Nguyen NT, Hinojosa MW, Slone J, Lee J, Khiatani V, Wilson SE. Laparoscopic transgastric access to the biliary tree after Roux-en-Y gastric bypass. Obes Surg. 2007;17:416–419. doi:10.1007/s11695-007-9051-0.

    Article  PubMed  Google Scholar 

  5. Tucker ON, Fajnwaks P, Szomstein S, Rosenthal RJ. Is concomitant cholecystectomy necessary in obese patients undergoing laparoscopic gastric bypass surgery? Surg Endosc. 2008 (in press).

  6. McPherson SJ, Gibson RN, Collier NA, Speer TG, Sherson ND. Percutaneous transjejunal biliary intervention: 10-year experience with access via Roux-en-Y loops. Radiology. 1998;206:665–672.

    PubMed  CAS  Google Scholar 

  7. Baron TH. Double-balloon enteroscopy to facilitate retrograde PEG placement as access for therapeutic ERCP in patients with long-limb gastric bypass. Gastrointest Endosc. 2006;64:973–974. doi:10.1016/j.gie.2006.06.044.

    Article  PubMed  Google Scholar 

  8. Elton E, Hanson BL, Qaseem T, Howell DA. Diagnostic and therapeutic ERCP using an enteroscope and a pediatric colonoscope in long-limb surgical bypass patients. Gastrointest Endosc. 1998;47:62–67. doi:10.1016/S0016-5107(98)70300-1.

    Article  PubMed  CAS  Google Scholar 

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

    PubMed  CAS  Google Scholar 

  10. Chahal P, Baron TH, Poterucha JJ, Rosen CB. Endoscopic retrograde cholangiography in post-orthotopic liver transplant population with Roux-en-Y biliary reconstruction. Liver Transpl.. 2007;13:1168–1173. doi:10.1002/lt.21198.

    Article  PubMed  Google Scholar 

  11. 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. doi:10.1055/s-2007-966841.

    Article  PubMed  CAS  Google Scholar 

  12. Chu YC, Su SJ, Yang CC, Yeh YH, Chen CH, Yueh SK. ERCP plus papillotomy by use of double-balloon enteroscopy after Billroth II gastrectomy. Gastrointest Endosc. 2007;66:1234–1236. doi:10.1016/j.gie.2007.04.030.

    Article  PubMed  Google Scholar 

  13. 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. doi:10.1016/j.gie.2007.06.056.

    Article  PubMed  Google Scholar 

  14. Fahndrich M, Sandmann M, Heike M. A facilitated method for endoscopic interventions at the bile duct after Roux-en-Y reconstruction using double-balloon enteroscopy. Z Gastroenterol. 2008;46:335–338. doi:10.1055/s-2007-963783.

    Article  PubMed  CAS  Google Scholar 

  15. Maaser C, Lenze F, Bokemeyer M, et al. Double-balloon enteroscopy: a useful tool for diagnostic and therapeutic procedures in the pancreaticobiliary system. Am J Gastroenterol. 2008;103:894–900. doi:10.1111/j.1572-0241.2007.01745.x.

    Article  PubMed  Google Scholar 

  16. Monkemuller K, Bellutti M, Neumann H, Malfertheiner P. Therapeutic ERCP with the double-balloon enteroscope in patients with Roux-en-Y anastomosis. Gastrointest Endosc. 2008;67:992–996. doi:10.1016/j.gie.2007.10.023.

    Article  PubMed  Google Scholar 

  17. Haruta H, Yamamoto H, Mizuta K, et al. A case of successful enteroscopic balloon dilation for late anastomotic stricture of choledochojejunostomy after living donor liver transplantation. Liver Transpl. 2005;11:1608–1610. doi:10.1002/lt.20623.

    Article  PubMed  Google Scholar 

  18. Chu YC, Yang CC, Yeh YH, Chen CH, Yueh SK. Double-balloon enteroscopy application in biliary tract disease-its therapeutic and diagnostic functions. Gastrointest Endosc. 2008;68(3):585–591.

    Article  PubMed  Google Scholar 

  19. Monkemuller K, Fry LC, Bellutti M, Neumann H, Malfertheiner P. ERCP using single-balloon instead of double-balloon enteroscopy in patients with Roux-en-Y anastomosis. Endoscopy. 2008 (in press).

  20. 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. doi:10.1055/s-2007-966976.

    Article  PubMed  CAS  Google Scholar 

  21. Davis MM, Slish K, Chao C, Cabana MD. National trends in bariatric surgery, 1996–2002. Arch Surg. 2006;141:71–74. doi:10.1001/archsurg.141.1.71. (Discussion 75).

    Article  PubMed  Google Scholar 

  22. Pai RD, Carr-Locke DL, Thompson CC. Endoscopic evaluation of the defunctionalized stomach by using ShapeLock technology (with video). Gastrointest Endosc. 2007;66:578–581. doi:10.1016/j.gie.2007.02.062.

    Article  PubMed  Google Scholar 

  23. Monkemuller K et al. Dig Dis. 2008 (in press).

Download references

Acknowledgments

This work was funded in part by NIH training Grant T32 DK007634.

Author information

Authors and Affiliations

  1. Center for Gastrointestinal Biology and Disease, Division of Gastroenterology and Hepatology, Department of Medicine, University of North Carolina School of Medicine, CB#7080, 4140 Bioinformatics Building, 130 Mason Farm Rd., Chapel Hill, NC, 27599-7080, USA

    Evan S. Dellon, Douglas R. Morgan & Ian S. Grimm

  2. Division of Gastrointestinal Surgery, Department of Surgery, University of North Carolina School of Medicine, Chapel Hill, NC, USA

    Geoffrey P. Kohn

Authors
  1. Evan S. Dellon
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Geoffrey P. Kohn
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Douglas R. Morgan
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Ian S. Grimm
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Evan S. Dellon.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Dellon, E.S., Kohn, G.P., Morgan, D.R. et al. Endoscopic Retrograde Cholangiopancreatography with Single-Balloon Enteroscopy Is Feasible in Patients with a Prior Roux-en-Y Anastomosis. Dig Dis Sci 54, 1798–1803 (2009). https://doi.org/10.1007/s10620-008-0538-x

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s10620-008-0538-x

Keywords

Search

Navigation