Comparison of double-balloon and single-balloon enteroscope for therapeutic endoscopic retrograde cholangiography after Roux-en-Y small bowel surgery.

Michael De Koning,Tom G Moreels

doi:10.1186/s12876-016-0512-6

Michael De Koning, Tom G Moreels

Open Access

https://doi.org/10.1186/s12876-016-0512-6

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Journal: BMC gastroenterology	Publication Date: Aug 22, 2016
Citations: 43	License type: cc-by

Affiliation: Antwerp University Hospital

Abstract

BackgroundRoux-en-Y reconstructive surgery excludes the biliopancreatic system from conventional endoscopic access. Balloon-assisted enteroscopy allows therapeutic endoscopic retrograde cholangiopancreatography (ERCP) in these patients, avoiding rescue surgery.The objective of the current study is to compare success and complication rate of double-balloon (DBE) and single-balloon enteroscope (SBE) to perform ERCP in Roux-en-Y patients.MethodsSeventy three Roux-en-Y patients with suspected biliary tract pathology underwent balloon-assisted enteroscopy in a tertiary-care center. Retrospective analysis of 95 consecutive therapeutic ERCP procedures was performed to define and compare success and complication rate of DBE and SBE.ResultsMale-female ratio was 28/45 with a mean age of 58 ± 2 years. 30 (32 %) procedures were performed with DBE and 65 (68 %) with SBE. Overall ERCP success rate was 73 % for DBE and 75 % for SBE (P = 0.831). Failure was due to inability to reach or cannulate the intact papilla or bilioenteric anastomosis. Success rate was significantly higher when performed at the bilioenteric anastomosis (80 % success in 56 procedures) or at the intact papilla in short-limb Roux-en-Y (80 % in 15 procedures) as compared to the intact papilla in long-limb (58 % in 24 procedures; P = 0.040). Adverse event rates were 10 % (DBE) and 8 % (SBE) (P = 0.707) and mostly dealt with conservatively.ConclusionsERCP after Roux-en-Y altered small bowel anatomy is feasible and safe using both DBE and SBE. Both techniques are equally competent with high success rates and acceptable adverse events rates. ERCP at the level of the intact papilla in long limb Roux-en-Y is less successful as compared to short-limb or bilioenteric anastomosis.

Highlights

Roux-en-Y reconstructive surgery excludes the biliopancreatic system from conventional endoscopic access
There was no specific randomisation, in retrospect, singleballoon enteroscope (SBE) was chosen more often than DBE. This can be explained by the shorter preparation time and the faster procedure steps, as has previously been shown [22]
We previously showed that 4 patients with Roux-en-Y bilioenteric anastomosis stenosis were repeatedly treated with endoscopic balloon dilation using both DBE and SBE with similar success [18]

Summary

Introduction

Roux-en-Y reconstructive surgery excludes the biliopancreatic system from conventional endoscopic access. Roux-en-Y enteroenteric anastomosis of the small bowel is a widely used surgical technique to drain the biliopancreatic system via an afferent jejunal limb, commonly used in gastrectomy procedures, bariatric and biliopancreatic surgery [1]. This type of surgery may predispose to postoperative biliary adverse events like cholangitis and common bile duct stones [2,3,4]. The Roux-en-Y small bowel reconstruction excludes the afferent limb and the biliary tree from conventional endoscopic access. Short-limb Roux-en-Y is used for bilioenteric/pancreatoenteric anastomosis and for (partial) gastrectomy with intact papilla, whereas long-limb Rouxen-Y in combination with intact papilla is used in several bariatric malabsorption surgical procedures [6]

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