Double-balloon enteroscopy application in biliary tract disease-its therapeutic and diagnostic functions.
BACKGROUND
On occasion, it is impossible to perform ERCP with a traditional duodenoscope in patients who have had a Billroth II gastrectomy or hepatojejunostomy, and who now have biliary tract problems. Repeat surgery is not a suitable course of action in these patients. Therefore, finding alternative modalities to resolve these obstructions is of great importance.


OBJECTIVE
To report successful endoscopic examination and treatment of difficult biliary obstructions by using double-balloon enteroscopy.


METHODS
Five patients.


METHODS
Cases series.


METHODS
Double-balloon enteroscopy (DBE) for biliary tract examination and treatment.


RESULTS
We report on 5 patients who underwent Billroth II gastrectomy or biliary tract Roux-en-Y surgery and who later had biliary tract obstruction from various causes. We were unable to perform ERCP with traditional duodenoscopy but successfully completed ERCP with DBE. DBE was originally designed to examine the small intestine. The successful biliary tract cannulation rate when using DBE is lower than with duodenoscope. We performed ERCP by using DBE a total of 5 times, with a successful biliary cannulation rate of 60%. We performed a special-method papillotomy in 2 patients. This method entailed inserting an electric sphincterotome through the percutaneous transhepatic cholangiography and drainage (PTCD) route after performing DBE intubation to the ampulla of Vater. We then successfully completed a papillotomy with an electric sphincterotome under DBE guidance.


CONCLUSIONS
DBE appears to be a promising alternative in the examination and treatment of biliary tract disease in patients after GI operations such as Billroth II gastrectomy and choledochojejunostomy.
Chu
Yen-Chang
YC
Division of Gastroenterology, Department of Internal Medicine, Show Chwan Memorial Hospital, Changhua, Taiwan.
Yang
Chi-Chieh
CC
Yeh
Yung-Hsiang
YH
Chen
Chien-Hua
CH
Yueh
Shing-Kao
SK
D000368:Aged; D000369:Aged, 80 and over; D014670:Ampulla of Vater / Q000473:pathology; D002404:Catheterization / Q000295:instrumentation / Q000379:methods*; D002760:Cholangiopancreatography, Endoscopic Retrograde; D002779:Cholestasis / Q000175:diagnosis* / Q000628:therapy*; D020776:Endoscopes, Gastrointestinal; D016099:Endoscopy, Gastrointestinal / Q000379:methods; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D018570:Risk Assessment; D012494:Sampling Studies; D012680:Sensitivity and Specificity; D013624:Taiwan; D016896:Treatment Outcome