Diagnostic and Therapeutic Endoscopic Retrograde Cholangiography Using a Short-Type Double-Balloon Endoscope in Patients With Altered Gastrointestinal Anatomy: A Multicenter Prospective Study in Japan.
OBJECTIVE
To evaluate the utility and safety of a short-type double-balloon endoscope (DBE) in the treatment of biliary disease in patients with surgically altered gastrointestinal (GI) anatomy.


METHODS
This study was conducted as a multicenter, single-arm, prospective trial at five tertiary academic care centers and three community-based hospitals in Japan. Consecutive patients with biliary disease with altered GI anatomy were prospectively included in this study.


RESULTS
A total of 311 patients underwent double-balloon endoscopic retrograde cholangiography (ERC). The success rate of reaching the target site, the primary end point, was 97.7% (95% confidence interval (CI): 95.4-99.1). The success rate of biliary cannulation and contrast injection of the targeted duct, the secondary end point, was 96.4% (95% CI: 93.6-98.2), and the therapeutic success rate was 97.9% (95% CI: 95.4-99.2). Adverse events occurred in 33 patients (10.6%, 95% CI: 7.1-14.0) and were managed conservatively in all patients with the exception of 1 in whom a perforation developed, requiring emergency surgery.


CONCLUSIONS
ERC using a short-type DBE resulted in an excellent therapeutic success rate and a low rate of adverse events. This treatment can be a first-line treatment for biliary disease in patients with surgically altered GI anatomy.
The Third Department of Internal Medicine, Division of Gastroenterology and Hepatology, Kansai Medical University, Osaka, Japan.
Masaaki
M
Shimatani
Department of Medicine, Division of Gastroenterology, Jichi Medical University, Tochigi, Japan.
Hisashi
H
Hatanaka
Department of Gastroenterology, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan.
Hirofumi
H
Kogure
Department of Gastroenterology and Hepatology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, Japan.
Koichiro
K
Tsutsumi
Department of Gastroenterology and Hepatology, Nagoya University Graduate School of Medicine, Nagoya, Japan.
Hiroki
H
Kawashima
Department of Gastroenterology, Onomichi General Hospital, Hiroshima, Japan.
Keiji
K
Hanada
Digestive Endoscopy Center, Sendai Kousei Hospital, Sendai, Japan.
Tomoki
T
Matsuda
Center for Gastroenterology, Otaru Ekisaikai Hospital, Hokkaido, Japan.
Tomoki
T
Fujita
The Third Department of Internal Medicine, Division of Gastroenterology and Hepatology, Kansai Medical University, Osaka, Japan.
Makoto
M
Takaoka
Department of Medicine, Division of Gastroenterology, Jichi Medical University, Tochigi, Japan.
Tomonori
T
Yano
Department of Gastroenterology, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan.
Atsuo
A
Yamada
Department of Gastroenterology and Hepatology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, Japan.
Hironari
H
Kato
The Third Department of Internal Medicine, Division of Gastroenterology and Hepatology, Kansai Medical University, Osaka, Japan.
Kazuichi
K
Okazaki
Department of Medicine, Division of Gastroenterology, Jichi Medical University, Tochigi, Japan.
Hironori
H
Yamamoto
Department of Molecular-Targeting Cancer Prevention, Kyoto Prefectural University of Medicine, Kyoto, Japan.
Hideki
H
Ishikawa
Department of Medicine, Division of Gastroenterology, Jichi Medical University, Tochigi, Japan.
Kentaro
K
Sugano
D000368:Aged; D000369:Aged, 80 and over; D001660:Biliary Tract Diseases / Q000000981:diagnostic imaging / Q000601:surgery; D001662:Biliary Tract Surgical Procedures; D002760:Cholangiopancreatography, Endoscopic Retrograde / Q000295:instrumentation* / Q000379:methods*; D002761:Cholangitis / Q000000981:diagnostic imaging* / Q000601:surgery / Q000628:therapy; D002769:Cholelithiasis / Q000000981:diagnostic imaging* / Q000601:surgery; D013505:Digestive System Surgical Procedures; D058582:Double-Balloon Enteroscopy / Q000295:instrumentation*; D004379:Duodenal Neoplasms / Q000601:surgery; D005260:Female; D015390:Gastric Bypass; D006801:Humans; D007564:Japan; D041781:Jaundice, Obstructive / Q000000981:diagnostic imaging* / Q000601:surgery; D008297:Male; D008875:Middle Aged; D010190:Pancreatic Neoplasms / Q000601:surgery; D011446:Prospective Studies; D019651:Plastic Surgery Procedures; D013274:Stomach Neoplasms / Q000601:surgery
Endoscopy. 2006 Dec;38(12):1241-5
17163326
Gastrointest Radiol. 1991 Summer;16(3):193-7
1879632
J Hepatobiliary Pancreat Sci. 2014 Apr;21(4):E22-8
24307491
Endoscopy. 2007 Dec;39(12):1068-71
18072058
Gastrointest Endosc. 2001 Feb;53(2):216-20
11174299
Am J Gastroenterol. 1999 Jan;94(1):144-8
9934745
Gastrointest Endosc. 2007 Nov;66(5):1038-41
17963892
Gastrointest Endosc. 2008 Sep;68(3):585-91
18561917
Dig Dis. 2008;26(4):324-9
19188723
Surg Endosc. 2009 Sep;23(9):1961-7
19067052
Ital J Gastroenterol Hepatol. 1998 Jun;30(3):301-5
9759601
Gastrointest Endosc. 2013 Apr;77(4):593-600
23290720
World J Gastroenterol. 2010 Sep 28;16(36):4594-8
20857532
Am J Gastroenterol. 2010 Oct;105(10):2294; author reply 2294-5
20927071
Dig Endosc. 2010 Jul;22(3):211-6
20642611
Dig Endosc. 2009 Jul;21(3):180-4
19691766
Endoscopy. 1997 Feb;29(2):69-73
9101141
World J Gastrointest Endosc. 2015 Jun 10;7(6):617-27
26078830
Am J Gastroenterol. 2008 Dec;103(12):3218-9
19086985
Gastrointest Endosc. 2010 Mar;71(3):446-54
20189503
Gastrointest Endosc. 2001 Jan;53(1):19-26
11154484
Hepatogastroenterology. 2005 Mar-Apr;52(62):356-9
15816434
Surg Endosc. 2011 Mar;25(3):713-21
20976503
Gastrointest Endosc. 1998 Jan;47(1):62-7
9468425
Gastrointest Endosc. 2002 Aug;56(2):225-32
12145601
Endoscopy. 1997 Feb;29(2):82-5
9101144
Gastrointest Endosc. 2008 May;67(6):992-6
18279869
Endoscopy. 1999 Sep;31(7):546-9
10533739
Dig Endosc. 2014 Jan;26 Suppl 1:70-8
24118126
Dig Dis Sci. 2010 Mar;55(3):874-5; author reply 875
20108120
Endoscopy. 2009;41 Suppl 2:E19-20
19219763
Gastrointest Endosc. 2007 Sep;66(3 Suppl):S47-50
17709030
Endoscopy. 2014 Jul;46(7):560-72
24839188
Hepatogastroenterology. 2005 Mar-Apr;52(62):352-5
15816433
World J Gastroenterol. 2012 Dec 14;18(46):6843-9
23239923
Gastrointest Endosc. 2005 Jan;61(1):112-25
15672074
Gut. 1986 Oct;27(10 ):1193-8
3781333
Can J Gastroenterol. 2011 Nov;25(11):615-9
22059169
World J Gastroenterol. 2011 May 14;17(18):2302-14
21633596
Endoscopy. 2009 Oct;41(10):849-54
19750447
Gut. 1984 Sep;25(9):971-4
6469083
Med Sci Monit. 2011 Feb 25;17(3):CS29-33
21358608
Gastrointest Endosc. 1975 May;21(4):164-5
1140534
Am J Gastroenterol. 2008 Apr;103(4):894-900
18371136
Gastroenterology. 1988 Jul;95(1):156-63
3371610
Dig Dis Sci. 2013 Mar;58(3):858-64
22975796