Endoscopic Retrograde Cholangiopancreatography in Patients with Previous Pancreaticoduodenectomy: A Single-Center Experience.
BACKGROUND
Performing ERCP in patients with previous pancreaticoduodenectomy (PD) is technically challenging. Balloon-assisted ERCP has recently been recognized as a useful tool in patients with surgically altered anatomies. However, there are few studies that focus on ERCP in post-PD patients.


OBJECTIVE
This study aimed to evaluate the outcome of ERCP in patients in post-PD and the patterns for type of endoscopes used.


METHODS
Patients with previous PD who had undergone ERCP were included in this retrospective study.


RESULTS
One hundred and thirty ERCP procedures were performed on 47 post-PD patients. The overall success of ERCP was 82.3 % (107/130). Endoscope insertion to the pancreaticobiliary anastomoses was accomplished in 93.8 % (122/130), which resulted in successful completion of ERCP in 87.7 % (107/122) of the procedures: 89.5 % (94/105) in biliary indications and 76.5 % (13/17) in pancreas indications. Using the conventional endoscopes (CEs) led to ERCP success in 66.4 % (71/107) of attempts versus 78.3 % (36/46) with balloon-assisted enteroscopes (BAEs). Among 105 cases in which CEs were initially tried, ERCP was successful in 69 (65.7 %) cases with CEs alone. When CEs failed to reach the pancreaticobiliary anastomoses, the subsequent use of BAEs resulted in a successful ERCP in 16/19 (84.2 %) of attempts.


CONCLUSIONS
ERCP in post-PD patients can be performed with a high success rate. We recommend that CEs should be used initially for ERCP in patients with PD and that BAEs be reserved for situation in which CEs have failed to reach the pancreaticobiliary anastomoses.
Division of Digestive Diseases, Cedars-Sinai Medical Center, Los Angeles, CA, USA. mintpbk@naver.com.|Division of Gastroenterology, Department of Internal Medicine, National Health Insurance Service Ilsan Hospital, Goyang, Gyeonggi, Korea. mintpbk@naver.com.
Byung Kyu
BK
Park
Division of Digestive Diseases, Cedars-Sinai Medical Center, Los Angeles, CA, USA.|Division of Gastroenterology, Department of Internal Medicine, Sanggye Paik Hospital, Inje University College of Medicine, Seoul, Korea.
Tae Joo
TJ
Jeon
Division of Gastroenterology, Department of Internal Medicine, University of Nevada School of Medicine, Las Vegas, NV, USA.
Vijay
V
Jayaraman
Idaho Gastroenterology Associates, Boise, ID, USA.
Christopher
C
Hammerle
Division of Digestive Diseases, Cedars-Sinai Medical Center, Los Angeles, CA, USA.
Kapil
K
Gupta
Division of Digestive Diseases, Cedars-Sinai Medical Center, Los Angeles, CA, USA.
Laith H
LH
Jamil
Division of Digestive Diseases, Cedars-Sinai Medical Center, Los Angeles, CA, USA.
Simon K
SK
Lo
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001660:Biliary Tract Diseases / Q000175:diagnosis / Q000601:surgery*; D002760:Cholangiopancreatography, Endoscopic Retrograde / Q000009:adverse effects / Q000295:instrumentation; D020776:Endoscopes, Gastrointestinal; D004867:Equipment Design; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D061646:Operative Time; D010182:Pancreatic Diseases / Q000175:diagnosis / Q000601:surgery*; D016577:Pancreaticoduodenectomy; D011183:Postoperative Complications / Q000209:etiology; D056910:Republic of Korea; D012189:Retrospective Studies; D013997:Time Factors; D016896:Treatment Outcome
Balloon-assisted enteroscope; Conventional endoscope; ERCP; Pancreaticoduodenectomy