Double-balloon enteroscopy for endoscopic retrograde cholangiography in patients with a Roux-en-Y anastomosis.
OBJECTIVE
Double-balloon enteroscopy (DBE) has been proved to be effective for deep intubation of the small bowel. Patients with a Roux-en-Y enteroanastomosis and biliary problems have been a challenge in gastrointestinal practice because of the lack of endoscopic access to the biliary anastomosis. We report on the first case series of patients with Roux-en-Y anatomy who have been examined using DBE.


METHODS
Between September 2005 and May 2006, 18 endoscopic retrograde cholangiography procedures were performed in 13 patients (median age 53, range 2 - 81 years) using the DBE technique at our hospital. Most of the cases (10/13) had had a liver transplant for primary sclerosing cholangitis. The Fujinon T-series DBE system was used in all cases.


RESULTS
The entero-enteric anastomosis was reached easily in all 18 procedures, and the end of the Roux limb was reached in 17/18 procedures. The mean intubation time was 40 minutes (range 5 - 120 minutes). Adequate imaging was achieved in all but two cases, one of whom had a native papilla. Biliary stenting was performed in two patients, stent removal in three patients, and removal of a small stone in one patient.


CONCLUSIONS
Endoscopic access and biliary cannulation in the setting of Roux-en-Y anatomy is safe and feasible using the new DBE system for enteral intubation. Adaptation of accessories would further improve the utility of the procedure.
Aabakken
L
L
Department of Medicine, Rikshospitalet-Radiumhospitalet Medical Center, Oslo, Norway. larsaa@medisin.uio.no
Bretthauer
M
M
Line
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PD
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000713:Anastomosis, Roux-en-Y; D001662:Biliary Tract Surgical Procedures / Q000379:methods; D053704:Capsule Endoscopy / Q000379:methods*; D002648:Child; D002675:Child, Preschool; D002760:Cholangiopancreatography, Endoscopic Retrograde / Q000379:methods*; D015331:Cohort Studies; D013505:Digestive System Surgical Procedures / Q000379:methods; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000175:diagnosis*; D018570:Risk Assessment; D012680:Sensitivity and Specificity