title: Double-balloon-enteroscopy-based endoscopic retrograde cholangiopancreatography in post-surgical patients.
abstract: OBJECTIVE
  To evaluate double balloon enteroscopy (DBE) in post-surgical patients to perform endoscopic retrograde cholangiopancreatography (ERCP) and interventions.
  
  
  METHODS
  In 37 post-surgical patients, a stepwise approach was performed to reach normal papilla or enteral anastomoses of the biliary tract/pancreas. When conventional endoscopy failed, DBE-based ERCP was performed and standard parameters for DBE, ERCP and interventions were recorded.
  
  
  RESULTS
  Push-enteroscopy (overall, 16 procedures) reached enteral anastomoses only in six out of 37 post-surgical patients (16.2%). DBE achieved a high rate of luminal access to the biliary tract in 23 of the remaining 31 patients (74.1%) and to the pancreatic duct (three patients). Among all DBE-based ERCPs (86 procedures), 21/23 patients (91.3%) were successfully treated. Interventions included ostium incision or papillotomy in 6/23 (26%) and 7/23 patients (30.4%), respectively. Biliary endoprosthesis insertion and regular exchange was achieved in 17/23 (73.9%) and 7/23 patients (30.4%), respectively. Furthermore, bile duct stone extraction as well as ostium and papillary dilation were performed in 5/23 (21.7%) and 3/23 patients (13.0%), respectively. Complications during DBE-based procedures were bleeding (1.1%), perforation (2.3%) and pancreatitis (2.3%), and minor complications occurred in up to 19.1%.
  
  
  CONCLUSIONS
  The appropriate use of DBE yields a high rate of luminal access to papilla or enteral anastomoses in more than two-thirds of post-surgical patients, allowing important successful endoscopic therapeutic interventions.
authors.affiliation: Department of Medicine 1, University of Erlangen-Nürnberg, Ulmenweg 18, 91054 Erlangen, Germany. martin.raithel@uk-erlangen.de
authors.forename: Martin
authors.initials: M
authors.lastname: Raithel
authors.forename: Harald
authors.initials: H
authors.lastname: Dormann
authors.forename: Andreas
authors.initials: A
authors.lastname: Naegel
authors.forename: Frank
authors.initials: F
authors.lastname: Boxberger
authors.forename: Eckhart G
authors.initials: EG
authors.lastname: Hahn
authors.forename: Markus F
authors.initials: MF
authors.lastname: Neurath
authors.forename: Juergen
authors.initials: J
authors.lastname: Maiss
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D014670:Ampulla of Vater / Q000601:surgery*; D000713:Anastomosis, Roux-en-Y; D002760:Cholangiopancreatography, Endoscopic Retrograde; D003137:Common Bile Duct Diseases / Q000601:surgery*; D058582:Double-Balloon Enteroscopy; D005260:Female; D006801:Humans; D008099:Liver / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D010179:Pancreas / Q000601:surgery; D011183:Postoperative Complications; D011446:Prospective Studies