Abstract
Recently, we have performed therapeutic endoscopic retrograde cholangiopangreatography (ERCP) using a newly developed short single-balloon enteroscope (sSBE; working length of 152 cm, working channel of 3.2 mm) in patients with surgically altered anatomy. To evaluate the usefulness and safety of sSBE for therapeutic ERCP in patients with surgically altered anatomy. Overall, 123 patients with surgically altered anatomy who underwent therapeutic ERCP using a sSBE between August 2011 and October 2017 were included in this study. Patient anatomy consisted of Roux-en-Y anastomosis (R-Y; n = 98), hepaticojejunostomy (HJ ; n = 11), and subtotal stomach-preserving pancreaticoduodenectomy (SSPPD ; n = 14). The indications for ERCP were choledocholithiasis (n = 80; R-Y), malignant biliary strictures (n = 22: R-Y, 16; HJ, 2; SSPPD, 4), intrahepatic stones (n= 11: HJ, 7; SSPPD, 4), and anastomotic stenosis (n = 8: SSPPD, 6; HJ, 2). The success rate of reaching the target site, the technical success rate, and the adverse event rate were retrospectively evaluated. The success rate of reaching the target site was 92% (113/123), and the overall technical success rate was 79% (97/123). Biliary interventions included 74 cases of stone extractions (R-Y, 66; HJ, 6; SSPPD, 2) and 12 cases of metallic biliary stent placement (R-Y, 7;HJ, 1;SSPPD, 4). Twenty-six unsuccessful cases underwent surgery (10 choledocholithiasis: R-Y,7; HJ,2; SSPPD,1), EUS-guided drainage (3 anastomotic stenosis: SSPPD, 4 malignant biliary stricture: R-Y, 3;SSPPD,1), percutaneous transhepatic biliary drainage (3 malignant bile duct stricture: R-Y), observation (5 choledocholithiasis: R-Y ), and palliative care (1 malignant biliary stricture: R-Y). The adverse event rate was 9% (n = 11: cholangitis, 4; mild pancreatitis, 3; perforation, 3; aspiration pneumonitis, 1). The two perforation cases required urgent operation, but the remaining nine cases were managed conservatively. Therapeutic ERCP using a sSBE in patients with surgically altered anatomy was considered safe and effective. However, another treatment such as EUS-guided drainage may be considered in difficult cases to perform ERCP as pancreaticojejunal anastomotic stenosis after SSPPD, malignant bile duct stricture in HJ and difficult biliary cannulation cases.
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