title: Utility of the short double-balloon enteroscope to perform pancreaticobiliary interventions in patients with surgically altered anatomy in a US multicenter study.
abstract: OBJECTIVE
  Double-balloon enteroscopy-assisted endoscopic retrograde cholangiopancreaticography (DBE-ERCP) is an effective method for interventions in the pancreaticobiliary system in the post-surgical patient. However, use of currently available endoscopic accessories during this procedure is limited due of the length of the conventional instrument (200 cm). The aim of this study was to explore the utility of the short DBE (152 cm) for the management of pancreaticobiliary disorders in patients with surgically altered anatomies.
  
  
  METHODS
  Data were collected retrospectively on patients with various anatomic variations in whom ERCP was performed using the short DBE from April 2008 to November 2011. Basic demographic information, clinical presentation, preoperative imaging, and type of surgery, procedural technical success rate, and adverse events were evaluated. Descriptive analysis was used to document the demographic and clinical data of the patients.
  
  
  RESULTS
  We identified 79 patients in whom DBE-ERCP was attempted (38 % male, mean age 58 years). Indications for the procedure were removal of a previously placed stent (n = 5), suspected sphincter of Oddi dysfunction type 1 (n = 3), surgical biliary leak (n = 3), pancreatic anastomotic stricture (n = 2), suspected biliary stones (n = 48), and biliary strictures visualized on imaging (n = 18). Overall, the success rate of DBE-ERCP in all patients was 81 % (64/79). The scope could not reach the papilla or surgical anastomosis in 8 cases and duct cannulation failed in 7 cases. The following interventions were performed: biliary sphincterotomy (n = 39), dilation of CBD stenosis with a balloon (n = 30), biliary stent insertion (n = 25), stone removal (n = 35), brushing cytology of biliary strictures (n = 3), and stent retrieval (n = 4). Three patients developed post-procedure pancreatitis. There was 1 episode of self-limited bleeding.
  
  
  CONCLUSIONS
  The current study demonstrates that DBE assisted ERCP for pancreaticobiliary interventions using a short enteroscope are feasible in patients with surgically altered anatomy.
authors.affiliation: Division of Gastroenterology and Hepatology, Department of Internal Medicine, Thomas Jefferson University Hospital, Philadelphia, PA, USA. ali.siddiqui@jefferson.edu
authors.forename: Ali A
authors.initials: AA
authors.lastname: Siddiqui
authors.forename: Adib
authors.initials: A
authors.lastname: Chaaya
authors.forename: Corbett
authors.initials: C
authors.lastname: Shelton
authors.forename: Jennifer
authors.initials: J
authors.lastname: Marmion
authors.forename: Thomas E
authors.initials: TE
authors.lastname: Kowalski
authors.forename: David E
authors.initials: DE
authors.lastname: Loren
authors.forename: Stephen J
authors.initials: SJ
authors.lastname: Heller
authors.forename: Oleh
authors.initials: O
authors.lastname: Haluszka
authors.forename: Douglas G
authors.initials: DG
authors.lastname: Adler
authors.forename: Jeffrey L
authors.initials: JL
authors.lastname: Tokar
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001659:Biliary Tract / Q000473:pathology*; D001662:Biliary Tract Surgical Procedures / Q000379:methods*; D058582:Double-Balloon Enteroscopy; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010179:Pancreas / Q000601:surgery*; D012189:Retrospective Studies; D014481:United States / Q000453:epidemiology