Abstract
Success rates of balloon enteroscopy-assisted endoscopic retrograde cholangiopancreatography (BE-ERCP) for patients with a reconstructed intestinal tract after surgical procedures are unsatisfactory. We retrospectively investigated the factors associated with unsuccessful BE-ERCP. Ninety-one patients who had a reconstructed intestinal tract after gastrectomy or choledochojejunostomy were enrolled. Age, sex, operative method, malignancy, endoscope type, endoscopist’s skill, emergency procedure, and time required to reach the papilla/anastomosis were examined. The primary endpoints were the factors associated with unsuccessful BE-ERCP selective cannulation, while the secondary endpoints were the rate of reaching the papilla/anastomosis, causes of failure to reach the papilla/anastomosis, cannulation success rate, procedure success rate, and rate of adverse events. Younger age (odds ratio, 0.832; 95% CI, 0.706–0.982; p = 0.001) and Roux-en-Y partial gastrectomy (odds ratio, 54.9; 95% CI, 1.09–2763; p = 0.045) were associated with unsuccessful BE- ERCP. The rate of reaching the papilla/anastomosis was 92.3%, the success rate of biliary duct cannulation was 90.5%, procedure success rate was 78.0%, and the rate of adverse events was 5.6%. In conclusion, Roux-en-Y partial gastrectomy and younger age were associated with unsuccessful BE-ERCP. If BE-ERCP is extremely difficult to perform in such patients after Roux-en-Y partial gastrectomy, alternative procedures should be considered early.
Highlights
Since it was first reported in 1968 [1], endoscopic retrograde cholangiopancreatography (ERCP) has been the standard endoscopic procedure for diseases of the pancreaticobiliary tract
If the difficulty in performing balloon enteroscopy can be predicted in advance, medical staff can prepare for alternative methods to ERCP, such as percutaneous bile duct drainage, surgery, and endoscopic ultrasound-guided bile duct drainage [27,28]
The primary endpoints were the factors associated with unsuccessful ERCP cannulation, and the secondary endpoints were the rate of reaching the papilla/anastomosis, causes of failure to reach the papilla/anastomosis, cannulation success rate, procedure success rate, and the rate of adverse events
Summary
Since it was first reported in 1968 [1], endoscopic retrograde cholangiopancreatography (ERCP) has been the standard endoscopic procedure for diseases of the pancreaticobiliary tract. If the difficulty in performing balloon enteroscopy can be predicted in advance, medical staff can prepare for alternative methods to ERCP, such as percutaneous bile duct drainage, surgery, and endoscopic ultrasound-guided bile duct drainage [27,28]. In this way, the endoscopic procedures performed in patients with reconstructed intestines would be safer and more accurate. The endoscopic procedures performed in patients with reconstructed intestines would be safer and more accurate In this retrospective study, we aimed to clarify the factors associated with unsuccessful BE-ERCP for pancreatic and biliary diseases in patients with postoperatively reconstructed intestines
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