title: Single-balloon enteroscopy effectively enables diagnostic and therapeutic retrograde cholangiography in patients with surgically altered anatomy.
abstract: BACKGROUND
  In patients with surgically altered anatomy, ERCP is often unsuccessful. Single-balloon enteroscopy (SBE) enables deep intubation of the small bowel, permitting diagnostic and therapeutic ERCP in this subset of patients.
  
  
  OBJECTIVE
  To determine the effectiveness of SBE in performing endoscopic retrograde cholangiography (ERC) in patients with surgically altered anatomy.
  
  
  METHODS
  Case series.
  
  
  METHODS
  Large quaternary-care center.
  
  
  METHODS
  Thirteen patients (11 women) underwent 16 SBE procedures with ERCP. Patient anatomy consisted of Whipple (n = 3), hepaticojejunostomy (n = 3), Billroth II (n = 1), and Roux-en-Y (n = 9).
  
  
  METHODS
  Patients with surgically altered anatomy in whom standard ERCP techniques had failed or were not possible underwent ERC by using SBE with initial therapeutic intent.
  
  
  METHODS
  Success rates of diagnostic ERC and therapeutic ERC in those patients who required biliary intervention. Procedure-related complications were also assessed.
  
  
  RESULTS
  Diagnostic ERC was successful 12 (92.3%) of 13 patients and in 13 (81.3%) of 16 cases. Therapeutic ERC was required in 10 patients in whom diagnostic ERC was first accomplished, and therapeutic ERC was successful in 9 (90%) of 10 patients. Biliary interventions included balloon dilation (n = 4), stone extraction (n = 2), sphincterotomy (n = 4), removal of a surgically placed stent (n = 3), and stenting (n = 2). Two patients developed pancreatitis after therapeutic ERC. Median follow-up was 53 days (range 22-522 days). Overall procedural success in an intent-to-treat analysis by case was 75%.
  
  
  CONCLUSIONS
  Single-center experience.
  
  
  CONCLUSIONS
  SBE enables diagnostic and therapeutic ERC in most patients with altered anatomy. SBE-assisted therapeutic ERC may be associated with an increased risk of pancreatitis. Improvement of the available equipment is necessary to perform more efficient and effective biliary interventions.
authors.affiliation: Division of Gastroenterology and Hepatology, Department of Medicine, University of Virginia Health System, Charlottesville, Virginia 22908, USA.
authors.forename: Andrew Y
authors.initials: AY
authors.lastname: Wang
authors.forename: Bryan G
authors.initials: BG
authors.lastname: Sauer
authors.forename: Brian W
authors.initials: BW
authors.lastname: Behm
authors.forename: Madhuri
authors.initials: M
authors.lastname: Ramanath
authors.forename: Dawn G
authors.initials: DG
authors.lastname: Cox
authors.forename: Kristi L
authors.initials: KL
authors.lastname: Ellen
authors.forename: Vanessa M
authors.initials: VM
authors.lastname: Shami
authors.forename: Michel
authors.initials: M
authors.lastname: Kahaleh
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000713:Anastomosis, Roux-en-Y; D001652:Bile Ducts / Q000601:surgery; D001660:Biliary Tract Diseases / Q000175:diagnosis* / Q000601:surgery / Q000628:therapy*; D002404:Catheterization; D002760:Cholangiopancreatography, Endoscopic Retrograde / Q000379:methods*; D002763:Cholecystectomy; D013505:Digestive System Surgical Procedures; D016099:Endoscopy, Gastrointestinal / Q000379:methods*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D016577:Pancreaticoduodenectomy; D016717:Sphincterotomy, Endoscopic; D015607:Stents