Balloon enteroscopy-assisted ERCP in patients with Roux-en-Y gastrectomy and intact papillae (with videos)

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• 作者：Kentaro Ishii ; MD¹ ; Takao Itoi ; MD ; FASGE¹ ; ; Ryosuke Tonozuka ; MD¹ ; Fumihide Itokawa ; MD¹ ; Atsushi Sofuni ; MD¹ ; Takayoshi Tsuchiya ; MD¹ ; Shujiro Tsuji ; MD¹ ; Nobuhito Ikeuchi ; MD¹ ; Kentaro Kamada ; MD¹ ; Junko Umeda ; MD¹ ; Reina Tanaka ; MD¹ ; Mitsuyoshi Honjo ; MD¹ ; Shuntaro Mukai ; MD¹ ; Mitsuru Fujita ; MD¹ ; Fuminori Moriyasu ; MD¹ ; Todd H. Baron ; MD ; FASGE² ; Takuji Gotoda ; MD ; FASGE¹
• 关键词：DBE ; double-balloon enteroscopy ; DGT ; double-guidewire technique ; EPLBD ; endoscopic papillary large-balloon dilation ; FVE ; forward-viewing endoscope ; OVE ; oblique-viewing endoscope ; PTC ; percutaneous transhepatic cholangiography ; RYG ; Roux-en-Y gastrectomy ; SBE ; single-balloon enteroscopy
• 刊名：Gastrointestinal Endoscopy
• 出版年：2016
• 出版时间：February 2016
• 年：2016
• 卷：83
• 期：2
• 页码：377-386.e6
• 全文大小：3032 K

文摘

Balloon enteroscopy–assisted ERCP has provided a marked improvement in the success rate of reaching the papilla and consecutive ERCP procedures in patients with surgically altered anatomy in the Roux-en-Y reconstruction setting. However, limited data are available on the outcome of balloon enteroscopy–assisted ERCP in patients with Roux-en-Y anatomy who have naïve papillae. We retrospectively evaluated the feasibility of balloon enteroscopy–assisted ERCP in Roux-en-Y reconstruction after total or subtotal gastrectomy (RYG) with native papillae.

Methods

We performed 123 ERCP procedures in 109 patients with RYG. Among these patients, 90 consecutive ERCPs in 90 patients with native papillae were included. When selective biliary cannulation failed, the double-guidewire technique, the precut technique, or the rendezvous technique were performed as advanced cannulation methods.

Results

The overall success rate of reaching the papilla was 93.5% (115/123). The total procedure success rate was 88.1% (96/109). The adverse event rate was 7.3% (8/109). The success rate of the standard cannulation of the intact papilla was 67.8% (61/90). The final cannulation success rate was 95.6% (86/90) by using advanced cannulation methods.

Conclusions

Standard cannulation of the intact papilla in RYG cases remains challenging and uncertain. The use of various advanced cannulation methods improves the deep cannulation rate. Once selective cannulation succeeds, the treatment success rate is very high.