title: Spiral assisted ERCP is equivalent to single balloon assisted ERCP in patients with Roux-en-Y anatomy.
abstract: BACKGROUND
  Endoscopic retrograde cholangiopancreatography (ERCP) is often unsuccessful in patients with Roux-en-Y anatomy. Augmented enteroscopy allows deep insertion into the small bowel and can be useful in patients with Roux-en-Y anatomy. The aim of this study was to compare single balloon assisted ERCP (SBE-ERCP) and spiral assisted ERCP (SE-ERCP) in patients with Roux-en-Y anatomy in terms of diagnostic and therapeutic yield, procedure time, and complications.
  
  
  METHODS
  This is a retrospective cohort study of consecutive patients with Roux-en-Y anatomy who underwent SBE-ERCP or SE-ERCP between October 2007 and March 2011. Diagnostic yield was defined as successful duct cannulation. Therapeutic yield was defined as the ability to successfully carry out endoscopic therapy in those cannulated. Procedure time and complications were assessed.
  
  
  RESULTS
  Thirty-four consecutive patients with Roux-en-Y anatomy underwent 54 ERCP procedures. The overall diagnostic yield was 44.4% with no significant difference between the diagnostic yield of SBE-ERCP (48.3%) and SE-ERCP (40%). The diagnostic yield was lower in patients with gastric by-pass (38.9%) compared with other types of Roux-en-Y anatomy (47.2%) but this was not statistically significant (P = 0.772). The overall therapeutic yield was 93.8%, with a therapeutic yield of 100% for SBE-ERCP and 87.5% for SE-ERCP (P = 1.0). There was one perforation during SBE-ERCP, giving a complication rate of 3.5%. The mean procedure time did not differ between the two techniques.
  
  
  CONCLUSIONS
  Diagnostic and therapeutic yields are similar with SBE-ERCP and SE-ERCP in patients with Roux-en-Y anatomy with no significant difference in procedure time or complication rates.
authors.affiliation: Division of Gastroenterology and Hepatology, Johns Hopkins University School of Medicine, 1830 East Monument Street, Baltimore, MD 21205, USA. amlennon@jhmi.edu
authors.forename: Anne Marie
authors.initials: AM
authors.lastname: Lennon
authors.forename: Sumit
authors.initials: S
authors.lastname: Kapoor
authors.forename: Mouen
authors.initials: M
authors.lastname: Khashab
authors.forename: Erin
authors.initials: E
authors.lastname: Corless
authors.forename: Stuart
authors.initials: S
authors.lastname: Amateau
authors.forename: Kerry
authors.initials: K
authors.lastname: Dunbar
authors.forename: Vinay
authors.initials: V
authors.lastname: Chandrasekhara
authors.forename: Vikesh
authors.initials: V
authors.lastname: Singh
authors.forename: Patrick I
authors.initials: PI
authors.lastname: Okolo
mesh_terms: D000328:Adult; D000368:Aged; D000713:Anastomosis, Roux-en-Y / Q000009:adverse effects*; D001652:Bile Ducts / Q000601:surgery; D002404:Catheterization / Q000009:adverse effects* / Q000295:instrumentation / Q000379:methods; D002760:Cholangiopancreatography, Endoscopic Retrograde / Q000295:instrumentation / Q000379:methods; D005260:Female; D006801:Humans; D007431:Intraoperative Complications / Q000453:epidemiology / Q000209:etiology; D008297:Male; D008875:Middle Aged; D010043:Outcome and Process Assessment, Health Care / Q000706:statistics & numerical data; D011183:Postoperative Complications / Q000175:diagnosis / Q000453:epidemiology / Q000209:etiology / Q000601:surgery; D012189:Retrospective Studies