Case studySingle-balloon enteroscopy effectively enables diagnostic and therapeutic retrograde cholangiography in patients with surgically altered anatomy
Section snippets
Methods
Patients with surgically altered gastroduodenal anatomy with a diagnosis requiring therapeutic ERC were offered SBE. SBE was performed by using a high-resolution standard-length enteroscope, with a 9.2-mm diameter and a 200-cm length (SIF-Q180; Olympus America, Center Valley, PA). A disposable sliding overtube, with a 13.2-mm outer diameter, an 11-mm inner diameter, a 130.2-cm length, and a hydrophilic coating over a silicone core (ST-SB1; Olympus America), was used to sequentially reduce and
Patient characteristics
Thirteen patients (2 men, 11 women) with a median age of 54 years (range 28-82 years) underwent 16 SBE procedures (cases), from October 2007 to April 2009, with the intent to perform therapeutic ERC (Table 1).
Surgically altered anatomy in the 16 procedures performed consisted of pancreaticoduodenectomy with HJ (Whipple, n = 3), HJ alone (n = 3), Billroth II with a long afferent limb (n = 1), Roux-en-Y anatomy after partial gastrectomy for ulcer disease (n = 1), and RYGB (n = 8). In 3 of the 16
Discussion
Historically, Billroth II gastrectomy was the predominant form of surgically altered anatomy that fostered challenging ERCP procedures. During the late 1990s and early 2000s, multiple studies reported excellent ERCP success by using duodenoscopes or enteroscopes in patients with Billroth II anatomy,19, 20, 21 likely because of shorter afferent limbs. However, the incidence of Billroth II surgeries has decreased because of more effective treatment for peptic ulcer disease.
Today, the surgically
References (36)
- et al.
ERCP in patients with long-limb Roux-en-Y gastrojejunostomy and intact papilla
Gastrointest Endosc
(2002) - et al.
Diagnostic and therapeutic ERCP using an enteroscope and a pediatric colonoscope in long-limb surgical bypass patients
Gastrointest Endosc
(1998) - et al.
Cholangiopancreatography, sphincterotomy, and common duct stone removal via Roux-en-Y limb enteroscopy
Gastroenterology
(1988) - et al.
ERCP via mature feeding jejunostomy tube tract in a patient with Roux-en-Y anatomy (with video)
Gastrointest Endosc
(2008) - et al.
Endoscopic evaluation of the defunctionalized stomach by using ShapeLock technology (with video)
Gastrointest Endosc
(2007) - et al.
Overtube-assisted ERCP in patients with surgically altered anatomy: a single center one-year experience
Gastrointest Endosc
(2009) - et al.
ERCP plus papillotomy by use of double-balloon enteroscopy after Billroth II gastrectomy
Gastrointest Endosc
(2007) - et al.
Double-balloon enteroscopy application in biliary tract disease-its therapeutic and diagnostic functions
Gastrointest Endosc
(2008) - et al.
Double-balloon ERCP in patients who have undergone Roux-en-Y surgery: a case series
Gastrointest Endosc
(2007) - et al.
A randomized trial of endoscopic balloon dilation and endoscopic sphincterotomy for removal of bile duct stones in patients with a prior Billroth II gastrectomy
Gastrointest Endosc
(2001)
Procedure incidence and in-hospital complication rates of bariatric surgery in the United States
Am J Surg
Long-term results of surgical repair of bile duct injuries following laparoscopic cholecystectomy
Surgery
Therapeutic ERCP with the double-balloon enteroscope in patients with Roux-en-Y anastomosis
Gastrointest Endosc
Endoscopic retrograde cholangiography in post-orthotopic liver transplant population with Roux-en-Y biliary reconstruction
Liver Transpl
Percutaneous transhepatic treatment of hepaticojejunal anastomotic biliary strictures after living donor liver transplantation
Liver Transpl
Bile leak following living donor liver transplantation: clinical efficacy of percutaneous transhepatic treatment
Liver Transpl
Management of major biliary complications after laparoscopic cholecystectomy
Ann Surg
Long-term outcome of gastric access loop in hepaticojejunostomy
Hepatobiliary Pancreat Dis Int
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DISCLOSURE: The following authors disclosed financial relationships relevant to this publication: V. M. Shami: Consultant for Olympus. M. Kahaleh: Grant support fromOlympus, Boston Scientific, Alveolus, ConMed, Cook Medical. All other authors disclosed no financial relationships relevant to this publication.