Mo1470 The Results of Post-Surgical Treatment of the Intestinal Tract for Common Bile Duct Calculus by DB-ERCP

Abstract

The Results of Post-Surgical Treatment of the Intestinal Tract for Common Bile Duct Calculus by DB-ERCP Shuhei Oana, Kazuyuki Suzuki, Toshimi Chiba, Masaki Endo, Shinji Saitou, Satosi Kasugai Gastroenterology and hepatrogy, Iwate Medical University, Morioka, Japan [Introduction] With the introduction of DBE, a biliary system treatment for postsurgical intestinal tract cases in which the duodenal papilla are difficult to reach with a conventional endoscope has become possible. The treatment results of common bile duct stone cases with DB-ERCPat our department are herein presented. [Subject] A total of 27 cases (33 instances), specifically, 18 males and 9 females with an average age of 75.0, who underwent treatment for common bile duct stone using DB-ERC at our department during the period from November 2004 to November 2010 were selected as subjects. Regarding the reconstructive procedures among these subjects, there were 22 cases of Roux-en Y reconstructive procedure and 5 cases of B-2 reconstructive procedure. [Results] The time taken to reach the duodenal papilla: The overall average time across all instances was 28.6 minutes (5 93 minutes). The rate at which the duodenal papilla was reached: 93.9% (31/33 instances). Success rates of cholangiography: 90.9% (30/33 instances) across all instances, and 96.3% (30/31 instances) if limited to those that reached the duodenal papilla. When observed according to the reconstructive procedure, the success rates were 96.2% (25/26 instances) for the Roux-en Y reconstructive procedure, and 100% (5/5 instances) for the B-2 reconstructive procedure, and it was possible to perform cholangiography. The success rate of crushing stones in a single attempt: Crushing stones in a single attempt was possible in 76.7% (23/30 instances) of cases, among cases in which cholangiography could be performed. The primary factors as to why stones could not be crushed in a single attempt: There were 5 cases in which the treatment tools could not be inserted because positions of the duodenal papilla were poor, or because the bile ducts were bent, and 2 cases in which insertion was stopped due to procedural time. Treatment time: On average, it took 100.3 minutes (14 164 minutes) for all procedures. Complications: Complications developed in 4 cases (13.8%), specifically 2 cases of mild acute pancreatitis, and 2 cases of retroperitoneal perforation; however, they subsided with conservative therapy. [Conclusion] Even when using DB-ERCP for the intestinal tract, it has now become possible to achieve higher rates of reaching the papilla by blind endings and higher rates of insertion into the intestinal tract. However, issues such as the presence of cases in which stones crushing treatment in a single attempt is difficult, low rates of success in single-attempt stones removal, and long treatment times have become clear, and it is believed that improvements are therefore necessary for both endoscopes and treatment instruments to provide improved emergency treatment for high risk patients and patients with severe cholangitis requiring dependable drainage.