Long- and short-type double-balloon enteroscopy-assisted therapeutic ERCP for intact papilla in patients with a Roux-en-Y anastomosis.
BACKGROUND
There have been a few previous reports on attempted double-balloon endoscopy (DBE)-assisted endoscopic retrograde cholangiopancreatography (ERCP) in patients with Roux-en-Y anastomosis and an intact papilla. This study was designed to evaluate the usefulness of DBE-assisted ERCP in patients with Roux-en-Y anastomosis and an intact papilla of Vater.


METHODS
Thirteen DBE procedures were performed in nine patients who had undergone Roux-en-Y reconstruction combined with eight total gastrectomies and one partial gastrectomy. Both short-type and long-type DBE were used. Long-type DBE was replaced with a conventional forward-viewing upper endoscope after reaching the papilla. Technical success rate, measurement of procedure times, and adverse events were evaluated in the retrospective study.


RESULTS
In all cases, the scopes could reach the papilla. The mean time required to reach the papilla was 48 (range, 13-90) min. There was a statistically significant difference with the short and long scope (29.0 ± 19.2 min vs. 64.8 ± 24.7 min, respectively; P = 0.044). The success rate of bile duct cannulation, resulting in achieving therapeutic ERCP on the first session was 66.7% (6/9). The mean procedural time in the successful cases was 128 (range, 47-183) min. Finally, therapeutic ERCP was achieved in all nine cases. There was one adverse event in which retroperitoneal perforation during lithotripsy, but that was successfully treated by conservative therapy alone.


CONCLUSIONS
DBE-assisted ERCP seems to be a promising option to perform therapeutic ERCP for intact papilla in patients with a Roux-en-Y anastomosis.
Department of Gastroenterology and Hepatology, Tokyo Medical University, Shinjuku-ku, Tokyo, Japan. itoi@tokyo-med.ac.jp
Takao
T
Itoi
Kentaro
K
Ishii
Atsushi
A
Sofuni
Fumihide
F
Itokawa
Takayoshi
T
Tsuchiya
Toshio
T
Kurihara
Shujiro
S
Tsuji
Nobuhito
N
Ikeuchi
Katsumasa
K
Fukuzawa
Fuminori
F
Moriyasu
Akihiko
A
Tsuchida
D000368:Aged; D014670:Ampulla of Vater / Q000601:surgery*; D000713:Anastomosis, Roux-en-Y; D002404:Catheterization / Q000295:instrumentation; D002760:Cholangiopancreatography, Endoscopic Retrograde / Q000295:instrumentation / Q000379:methods*; D019723:Endoscopes; D016099:Endoscopy, Gastrointestinal; D004867:Equipment Design; D005260:Female; D042882:Gallstones / Q000601:surgery; D005743:Gastrectomy / Q000379:methods; D006801:Humans; D008207:Lymphatic Metastasis; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D013274:Stomach Neoplasms / Q000601:surgery; D013997:Time Factors; D016896:Treatment Outcome