Abstract
Endoscopic Retrograde Cholangiopancreatography (ERCP) in patients with surgically-altered GI anatomy remains a technical challenge. Single balloon enteroscope (SBE) and double balloon enteroscope (DBE) assisted ERCP have been used with some limitations due to small working channel (2.8mm) and scope length (2300mm). The newly developed therapeutic short double-balloon enteroscope (T-sDBE) with 3.2 mm working channel and 1550 mm working length allows an easier handling of accessories designed for therapeutic ERCP. However, the existing data about this device is limited. This study aimed to assess the technical success of T-sDBE and compared it to conventional balloon-assisted enteroscope (C-BAE). A retrospective study of ERCP database during 2009-2019. Patients with surgically-altered GI anatomy undergoing BAE-ERCP were reviewed. Types of BAE included T-sDBE (EI-580BT), and C-BAE including DBE (EN-580T) and SBE (SIF-Q180). Definitions: enteroscopy success = able to reach ampulla, technical success = able to perform intervention, and clinical success = resolution of symptoms and normalization of bilirubin level. Forty-eight patients underwent 101 ERCP procedures: 75% C-BAE and 25% T-sDBE. The majority of surgical anatomy were Roux-En-Y hepaticojejonostomy (RYHJ) (55.4%), Whipple (23.8%), Billroth II (5.9%). The common diagnosis included bile duct stone (61.4%), anastomotic stricture (44.6%). The overall technical success rate was 62.4% (95% CI 52.5-72.3%), and clinical success rate was 59.4% (95%CI 49.5-69.3%). Seventy-eight interventions were performed including biliary stent insertion (90%), balloon dilation (28%), and stone extraction (18%). Adverse events occurred in 4% and all were post-ERCP cholangitis. When compared to the C-BAE, the T-sDBE was equivalent in terms of enteroscopy success (66.2% vs 72.0 %, p=0.593), and technical success (59.5% vs 68.0%, p=0.448) (Table 1). Among those with enteroscopy success, both T-sDBE and C-BAE provided high technical success of 94.4% and 89.8% (p=1.0) respectively. In patients with long limb such as RYHJ, the sDBE offered an equally good enteroscopy and technical success as C-BAE (75% Vs 71.1%, p=1.0 and 91.7% Vs 88.9%, p=1.0 respectively). The T-sDBE was as effective as C-BAE in regard to enteroscopy success. However, an increased technical success was not demonstrated despite larger working channel in our study cohort where most of the interventions required was biliary stent placement for the treatment of biliary anastomotic stricture in RYHJ anatomy. Further studies are required to better assess the benefits of this new device.
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