title: Effective "short" double-balloon enteroscope for diagnostic and therapeutic ERCP in patients with altered gastrointestinal anatomy: a large case series.
abstract: OBJECTIVE
  Although endoscopic retrograde cholangiopancreatography (ERCP) is technically challenging in patients with altered gastrointestinal anatomy, a double-balloon enteroscope (DBE) permits examinations of a much longer segment of the small bowel than does a standard endoscope, and may be used to perform ERCP in such patients. Since only limited accessories are available for a conventional DBE, we performed ERCP with a "short" DBE, which has a 2.8-mm working channel and a 152-cm working length and for which conventional accessories are available, in patients with altered gastrointestinal anatomy, and evaluated this alternative technique.
  
  
  METHODS
  In 68 patients with a Roux-en-Y total gastrectomy (n = 36), Billroth II gastrectomy (n = 17), or pancreatoduodenectomy (n = 15), ERCP (103 procedures) was performed with a "short" DBE.
  
  
  RESULTS
  Deep insertion was successful in 100/103 procedures (97 %). Cholangiogram was successfully obtained in 98/100 procedures (98 %). Treatment was accomplished in all 98 procedures in which a cholangiogram was obtained (100 %). Therapeutic interventions including stone extraction (n = 47), nasobiliary drainage (n = 38), stent placement (n = 36), sphincterotomy (n = 31), choledochojejunostomy dilation (n = 29), tumor biopsy (n = 10), and naso-pancreatic duct drainage (n = 1) were performed successfully. Complications occurred in 5/103 procedures (5 %), all in patients with Roux-en-Y reconstruction.
  
  
  CONCLUSIONS
  Despite the relatively high rate of complications seen in patients with Roux-en-Y reconstruction, ERCP with a "short" DBE is effective in patients who have undergone bowel reconstruction.
authors.affiliation: Third Department of Internal Medicine, Kansai Medical University, Osaka 573-1191, Japan. shimatam@hirakata.kmu.ac.jp
authors.forename: M
authors.initials: M
authors.lastname: Shimatani
authors.forename: M
authors.initials: M
authors.lastname: Matsushita
authors.forename: M
authors.initials: M
authors.lastname: Takaoka
authors.forename: M
authors.initials: M
authors.lastname: Koyabu
authors.forename: T
authors.initials: T
authors.lastname: Ikeura
authors.forename: K
authors.initials: K
authors.lastname: Kato
authors.forename: T
authors.initials: T
authors.lastname: Fukui
authors.forename: K
authors.initials: K
authors.lastname: Uchida
authors.forename: K
authors.initials: K
authors.lastname: Okazaki
mesh_terms: D000713:Anastomosis, Roux-en-Y; D002404:Catheterization; D002760:Cholangiopancreatography, Endoscopic Retrograde / Q000295:instrumentation* / Q000379:methods*; D005260:Female; D005763:Gastroenterostomy; D005767:Gastrointestinal Diseases / Q000175:diagnosis* / Q000601:surgery*; D041981:Gastrointestinal Tract / Q000002:abnormalities*; D006801:Humans; D008297:Male; D016577:Pancreaticoduodenectomy