title: Direct cholangioscopy combined with double-balloon enteroscope-assisted endoscopic retrograde cholangiopancreatography.
abstract: Double-balloon enteroscope (DBE)-assisted endoscopic retrograde cholangiopancreatography (ERCP) is an effective endoscopic approach for pancreatobiliary disorders in patients with altered gastrointestinal anatomy. Endoscopic interventions via DBE in these postoperative settings remain difficult because of the lack of an elevator and the use of extra-long ERCP accessories. Here, we report the usefulness of direct cholangioscopy with an ultra-slim gastroscope during DBE-assisted ERCP. Three patients with choledocholithiasis in postoperative settings (two patients after Billroth II gastrojejunostomy and one patient after Roux-en-Y gastrojejunostomy) were treated. DBE was used to gain access to the papilla under carbon dioxide insufflation, and endoscopic sphincterotomy was performed with a conventional sphincterotome. For direct cholangioscopy, the enteroscope was exchanged for an ultra-slim gastroscope through an incision in the overtube, which was inserted directly into the bile duct. Direct cholangioscopy was used to extract retained bile duct stones in two cases and to confirm the complete clearance of stones in one case. Bile duct stones were eliminated with a 5-Fr basket catheter under direct visual control. No adverse events were noted in any of the three cases. Direct cholangioscopy with an ultra-slim gastroscope facilitates subsequent treatment within the bile duct. This procedure represents another potential option during DBE-assisted ERCP.
authors.affiliation: Department of Gastroenterology, Kyoto City Hospital, Kyoto 6048845, Japan. tkoshitani@aol.com
authors.forename: Tatsuya
authors.initials: T
authors.lastname: Koshitani
authors.forename: Shogo
authors.initials: S
authors.lastname: Matsuda
authors.forename: Koji
authors.initials: K
authors.lastname: Takai
authors.forename: Takayuki
authors.initials: T
authors.lastname: Motoyoshi
authors.forename: Makoto
authors.initials: M
authors.lastname: Nishikata
authors.forename: Yasuhide
authors.initials: Y
authors.lastname: Yamashita
authors.forename: Toshihiko
authors.initials: T
authors.lastname: Kirishima
authors.forename: Naomi
authors.initials: N
authors.lastname: Yoshinami
authors.forename: Hiroyuki
authors.initials: H
authors.lastname: Shintani
authors.forename: Toshikazu
authors.initials: T
authors.lastname: Yoshikawa
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000713:Anastomosis, Roux-en-Y / Q000379:methods; D017546:Angioscopy / Q000379:methods*; D001662:Biliary Tract Surgical Procedures; D002760:Cholangiopancreatography, Endoscopic Retrograde / Q000379:methods*; D042883:Choledocholithiasis / Q000601:surgery; D002779:Cholestasis / Q000601:surgery; D058582:Double-Balloon Enteroscopy / Q000379:methods*; D020776:Endoscopes, Gastrointestinal; D015390:Gastric Bypass / Q000379:methods; D005762:Gastroenterology / Q000379:methods*; D006801:Humans; D008297:Male; D016896:Treatment Outcome