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Spiral Assisted ERCP Is Equivalent to Single Balloon Assisted ERCP in Patients with Roux-en-Y Anatomy

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Abstract

Background

Endoscopic retrograde cholangiopancreatography (ERCP) is often unsuccessful in patients with Roux-en-Y anatomy. Augmented enteroscopy allows deep insertion into the small bowel and can be useful in patients with Roux-en-Y anatomy. The aim of this study was to compare single balloon assisted ERCP (SBE-ERCP) and spiral assisted ERCP (SE-ERCP) in patients with Roux-en-Y anatomy in terms of diagnostic and therapeutic yield, procedure time, and complications.

Methods

This is a retrospective cohort study of consecutive patients with Roux-en-Y anatomy who underwent SBE-ERCP or SE-ERCP between October 2007 and March 2011. Diagnostic yield was defined as successful duct cannulation. Therapeutic yield was defined as the ability to successfully carry out endoscopic therapy in those cannulated. Procedure time and complications were assessed.

Results

Thirty-four consecutive patients with Roux-en-Y anatomy underwent 54 ERCP procedures. The overall diagnostic yield was 44.4% with no significant difference between the diagnostic yield of SBE-ERCP (48.3%) and SE-ERCP (40%). The diagnostic yield was lower in patients with gastric by-pass (38.9%) compared with other types of Roux-en-Y anatomy (47.2%) but this was not statistically significant (P = 0.772). The overall therapeutic yield was 93.8%, with a therapeutic yield of 100% for SBE-ERCP and 87.5% for SE-ERCP (P = 1.0). There was one perforation during SBE-ERCP, giving a complication rate of 3.5%. The mean procedure time did not differ between the two techniques.

Conclusion

Diagnostic and therapeutic yields are similar with SBE-ERCP and SE-ERCP in patients with Roux-en-Y anatomy with no significant difference in procedure time or complication rates.

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Abbreviations

ASA:

American Society of Anesthesiology

CO2:

Carbon dioxide

DBE:

Double balloon enteroscopy

ERCP:

Endoscopic retrograde cholangiopancreatography

HIPPA:

Health insurance portability and accountability act

MAC:

Monitored anaesthetic care

PTC:

Percutaneous transhepatic cholangiography

SBE-ERCP:

Single balloon assisted ERCP

SE-ERCP:

Spiral assisted ERCP

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Authors and Affiliations

  1. Division of Gastroenterology and Hepatology, Johns Hopkins University School of Medicine, 1830 East Monument Street, Baltimore, MD, 21205, USA

    Anne Marie Lennon, Mouen Khashab, Stuart Amateau, Vikesh Singh & Patrick I. Okolo III

  2. Sinai Hospital Program in Internal Medicine, Johns Hopkins University, Baltimore, MD, USA

    Sumit Kapoor

  3. Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA

    Erin Corless

  4. Division of Gastroenterology and Hepatology, Department of Medicine, VA North Texas Healthcare System, University of Texas Southwestern Medical School, Dallas, TX, USA

    Kerry Dunbar

  5. Gastroenterology Division, University of Pennsylvania Health System, Philadelphia, PA, USA

    Vinay Chandrasekhara

Authors
  1. Anne Marie Lennon
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  2. Sumit Kapoor
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  3. Mouen Khashab
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  4. Erin Corless
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  5. Stuart Amateau
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  6. Kerry Dunbar
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  7. Vinay Chandrasekhara
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  8. Vikesh Singh
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  9. Patrick I. Okolo III
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Correspondence to Anne Marie Lennon.

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Lennon, A.M., 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 57, 1391–1398 (2012). https://doi.org/10.1007/s10620-011-2000-8

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  • DOI: https://doi.org/10.1007/s10620-011-2000-8

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