ERCP with the Balloon-Assisted Enteroscopy Technique: A Systematic Review

Abstract

Background: Endoscopic retrograde cholangiopancreatography (ERCP) is generally difficult with conventional instruments in patients with surgically altered gastrointestinal anatomy. Balloon-assisted enteroscopy is a relatively new technique that allows for access to the papilla of Vater or a biliodigestive anastomosis in postsurgical reconstructions. Aim: To systematically review the utility of balloon-enteroscope-assisted ERCP for patients with altered gastrointestinal anatomy. Material and Methods: Systematic search of the literature on diagnostic and therapeutic interventions in the pancreaticobiliary system using balloon-assisted enteroscopy in patients with previous intestinal surgery indexed in of MEDLINE, Current Contents, PubMed, and references from relevant articles using the search terms ‘balloon’, ‘enteroscopy’, ‘endoscopy’, ‘ERCP’ and ‘cholangiography’. Only papers published as ‘full text’ in English were included. Results: In total, 16 relevant reports are available on balloon-assisted procedures performed in 63 patients with a variety of anatomical configurations. Double balloon procedures as well as single balloon techniques have been reported. Successful interventions in these patients include balloon dilation of stenotic biliodigestive anastomoses, sphincterotomy, extraction of bile stones and stent placement. No serious complications have yet been reported. Conclusions: Balloon-assisted enteroscopy is a safe and feasible technique to obtain biliary or pancreatic access in patients with surgically altered anatomical configurations. The diagnostic and therapeutic potential of balloon-assisted ERCP is large, and could be further improved if customized accessories become more widely available.