title: Short-type single balloon enteroscope for endoscopic retrograde cholangiopancreatography with altered gastrointestinal anatomy.
abstract: OBJECTIVE
  To evaluate the effectiveness of a short-type single-balloon-enteroscope (SBE) for endoscopic retrograde cholangiopancreatography (ERCP) in patients with a reconstructed intestine.
  
  
  METHODS
  Short-type SBE was developed to perform ERCP in postoperative patients with a reconstructed intestine. Short-type SBE is a direct-viewing endoscope with the following specifications: working length, 1520 mm; total length, 1840 mm; channel diameter, 3.2 mm. In addition, short-type SBE has a water-jet channel. The study group comprised 22 patients who underwent 31 sessions of short-type SBE-assisted ERCP from June 2011 through May 2012. Reconstruction was performed by Billroth-II (B-II) gastrectomy in 6 patients (8 sessions), Roux-en-Y (R-Y) gastrectomy in 14 patients (21 sessions), and R-Y hepaticojejunostomy in 2 patients (2 sessions). We retrospectively studied the rate of reaching the blind end (papilla of Vater or choledochojejunal anastomosis), mean time required to reach the blind end, diagnostic success rate (defined as the rate of successfully imaging the bile and pancreatic ducts), therapeutic success rate (defined as the rate of successfully completing endoscopic treatment), mean procedure time, and complications.
  
  
  RESULTS
  Among the 31 sessions of ERCP, the rate of reaching the blind end was 88% in B-II gastrectomy, 91% in R-Y gastrectomy, and 100% in R-Y hepaticojejunostomy. The mean time required to reach the papilla was 18.3 min in B-II gastrectomy, 21.1 min in R-Y gastrectomy, and 32.5 min in R-Y hepaticojejunostomy. The diagnostic success rates in all patients and those with an intact papilla were respectively 86% and 86% in B-II gastrectomy, 90% and 87% in R-Y gastrectomy, and 100% in R-Y hepaticojejunostomy. The therapeutic success rates in all patients and those with an intact papilla were respectively 100% and 100% in B-II gastrectomy, 94% and 92% in R-Y gastrectomy, and 100% in R-Y hepaticojejunostomy. Because the channel diameter was 3.2 mm, stone extraction could be performed with a wire-guided basket in 12 sessions, and wire-guided intraductal ultrasonography could be performed in 8 sessions. As for complications, hyperamylasemia (defined as a rise in serum amylase levels to more than 3 times the upper limit of normal) occurred in 1 patient (7 sessions) with a B-II gastrectomy and 4 patients (19 sessions) with an R-Y gastrectomy. After ERCP in patients with an R-Y gastrectomy, 2 patients (19 sessions) had pancreatitis, 1 patient (21 sessions) had gastrointestinal perforation, and 1 patient (19 sessions) had papillary bleeding. Pancreatitis and bleeding were both mild. Gastrointestinal perforation improved after conservative treatment.
  
  
  CONCLUSIONS
  Short-type SBE is effective for ERCP in patients with a reconstructed intestine and allows most conventional ERCP devices to be used.
authors.affiliation: Department of Gastroenterology, Kitasato University East Hospital, Sagamihara, Kanagawa 252-0380, Japan. yhiroshi@kitasato-u.ac.jp
authors.forename: Hiroshi
authors.initials: H
authors.lastname: Yamauchi
authors.forename: Mitsuhiro
authors.initials: M
authors.lastname: Kida
authors.forename: Kosuke
authors.initials: K
authors.lastname: Okuwaki
authors.forename: Shiro
authors.initials: S
authors.lastname: Miyazawa
authors.forename: Tomohisa
authors.initials: T
authors.lastname: Iwai
authors.forename: Miyoko
authors.initials: M
authors.lastname: Takezawa
authors.forename: Hidehiko
authors.initials: H
authors.lastname: Kikuchi
authors.forename: Maya
authors.initials: M
authors.lastname: Watanabe
authors.forename: Hiroshi
authors.initials: H
authors.lastname: Imaizumi
authors.forename: Wasaburo
authors.initials: W
authors.lastname: Koizumi
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D014670:Ampulla of Vater / Q000473:pathology / Q000601:surgery*; D002760:Cholangiopancreatography, Endoscopic Retrograde / Q000009:adverse effects / Q000295:instrumentation*; D020776:Endoscopes, Gastrointestinal; D004867:Equipment Design; D005260:Female; D006471:Gastrointestinal Hemorrhage / Q000209:etiology; D006801:Humans; D007416:Intestinal Perforation / Q000209:etiology; D007422:Intestines / Q000473:pathology / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D010195:Pancreatitis / Q000209:etiology; D011237:Predictive Value of Tests; D012189:Retrospective Studies; D016896:Treatment Outcome
keywords: Billroth-II gastrectomy; Endoscopic retrograde cholangiopancreatography; Roux-en-Y gastrectomy; Short type; Single-balloon-enteroscope
references.citation: Surg Endosc. 2011 Mar;25(3):713-21
references.pmid: 20976503
references.citation: Endoscopy. 2008 Jan;40(1):11-5
references.pmid: 18058613
references.citation: Digestion. 2009;80(1):52-7
references.pmid: 19478486
references.citation: Dig Dis Sci. 2009 Aug;54(8):1798-803
references.pmid: 18989776
references.citation: Am J Gastroenterol. 2010 Jan;105(1):93-9
references.pmid: 19809409
references.citation: World J Gastroenterol. 2011 May 14;17(18):2302-14
references.pmid: 21633596
references.citation: Gastrointest Endosc. 1991 May-Jun;37(3):383-93
references.pmid: 2070995
references.citation: Gastrointest Endosc. 2010 Mar;71(3):641-9
references.pmid: 20189529
references.citation: Endoscopy. 2009 Oct;41(10):849-54
references.pmid: 19750447
references.citation: World J Gastrointest Endosc. 2010 Sep 16;2(9):314-7
references.pmid: 21160763
references.citation: Gastrointest Endosc. 2008 Sep;68(3):585-91
references.pmid: 18561917
references.citation: Endoscopy. 2007 Dec;39(12):1068-71
references.pmid: 18072058
references.citation: Can J Gastroenterol. 2011 Nov;25(11):615-9
references.pmid: 22059169
references.citation: Dig Endosc. 2010 Jan;22(1):64-8
references.pmid: 20078669
references.citation: Gastrointest Endosc. 2005 Jul;62(1):62-70
references.pmid: 15990821
references.citation: Gastrointest Endosc. 2008 Dec;68(6):1112-6
references.pmid: 18599052
references.citation: Endoscopy. 2007 Feb;39 Suppl 1:E196-7
references.pmid: 17614060
references.citation: Liver Transpl. 2005 Dec;11(12):1608-10
references.pmid: 16315301
references.citation: Surg Endosc. 2010 Feb;24(2):466-70
references.pmid: 19585072
references.citation: Gastrointest Endosc. 2007 Nov;66(5):1038-41
references.pmid: 17963892
references.citation: Endoscopy. 2008 Sep;40 Suppl 2:E19-20
references.pmid: 18278720
references.citation: Endoscopy. 2010 Aug;42(8):656-60
references.pmid: 20589594
references.citation: Gastrointest Endosc. 2008 May;67(6):992-6
references.pmid: 18279869