Single-balloon enteroscopy-assisted endoscopic retrograde cholangiopancreaticography in patients with surgically altered anatomy: higher failure rate in malignant biliary obstruction - a prospective single center cohort analysis.
BACKGROUND
The performance of endoscopic retrograde cholangiopancreaticography (ERCP) in patients with post-surgically altered anatomy is technically ambitious. Our study aimed at comparing a cohort of patients having successfully undergone single-balloon enteroscopy (SBE)-assisted ERCP to those in whom SBE-ERCP failed.


METHODS
This trial is a prospective single center cohort study. Participants included 30 patients (median age 69.5 years, range 20-86 years) with previous pancreaticobiliary surgery. First, a conventional ERCP approach was attempted in all patients. Additionally, those patients in whom prior conventional ERCP had failed underwent SBE-ERCP (n = 26). Patients' baseline characteristics were retrieved and patient cohorts with and without successful SBE-ERCPs were compared and analyzed. Statistical analysis was applied. Univariate analysis was performed to detect possible risk factors of SBE-ERCP failure.


RESULTS
The overall success rate of SBE-ERCP, including two patients with percutaneous transhepatic cholangiography- assisted rendezvous technique was 65.4% (17/26). Patients with malignant obstructive cholestasis had a significantly higher failure rate compared to those with benign strictures (84.2% vs. 14.2%, p < 0.001).


CONCLUSIONS
SBE-ERCP is a promising tool for diagnostic and therapeutic procedures in the pancreaticobiliary system of selected, previously operated patients with failure of conventional ERCP. However, higher failure rates in malignant biliary obstruction should be taken into account.
Department of Medicine B, University of Muenster , Muenster , Germany.
Frank
F
Lenze
Tobias
T
Meister
Philipp
P
Matern
Hauke Sebastian
HS
Heinzow
Wolfram
W
Domschke
Hansjoerg
H
Ullerich
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000713:Anastomosis, Roux-en-Y; D002760:Cholangiopancreatography, Endoscopic Retrograde / Q000009:adverse effects / Q000379:methods*; D042883:Choledocholithiasis / Q000628:therapy; D002779:Cholestasis / Q000209:etiology* / Q000628:therapy; D004067:Digestive System Neoplasms / Q000150:complications*; D016099:Endoscopy, Gastrointestinal / Q000009:adverse effects; D005260:Female; D005743:Gastrectomy; D015390:Gastric Bypass; D006801:Humans; D008297:Male; D008875:Middle Aged; D016577:Pancreaticoduodenectomy; D010193:Pancreaticojejunostomy; D011446:Prospective Studies; D016896:Treatment Outcome; D055815:Young Adult
endoscopic retrograde cholangiopancreaticography; single balloon; single balloon enteroscopy endoscopic retrograde cholangiopancreaticography; surgically altered anatomy