Short-type Single-balloon Enteroscope Research Articles

A novel cannula with a movable tip facilitates cannulation during endoscopic retrograde cholangiopancreatography in reconstructed intestinal tracts.

An 83-year-old woman was admitted with obstructive jaundice. She was diagnosed with pancreatic head cancer after a close examination ([Fig. 1]). She had previously undergone total gastrectomy with Roux-en-Y reconstruction and caudal pancreatectomy for pancreatic body cancer. Thus, we attempted to treat the obstructive jaundice via endoscopic retrograde cholangiopancreatography (ERCP) using a short-type single-balloon enteroscope.

Feasibility of Rescue Colonoscopy Using a Short-type Enteroscope (SIF-H290S) without Overtube after Incomplete Colonoscopy: A Single-center Retrospective Pilot Study.

Recently, a newly designed short-type single-balloon enteroscope (SBE), SIF-H290S, has been developed with a smaller outer diameter and a longer working length than conventional colonoscopes. It has passive bending and high-force transmission, making insertion easier. However, it is difficult to perform rescue colonoscopy with an SBE after incomplete colonoscopy in the same session. Therefore, this study evaluated the feasibility of consecutive rescue colonoscopy using SIF-H290S without overtube after incomplete colonoscopy. This was a single-center retrospective study. We included 19 rescue colonoscopies (19 patients) with SIF-H290S without overtube performed by 11 endoscopists in the SIF group and 38 rescue colonoscopies (38 patients) using a small-caliber colonoscope (PCF-PQ260L) were randomly selected for the control group from procedures performed by the same 11 endoscopists. We compared the cecal intubation rate and other outcomes, such as insertion time, between the two groups. The median age of the patients was 72 and 69 years, with 8 and 26 males in the SIF and control groups, respectively. The median body mass index was 21.6 and 22.7 kg/m2 in the SIF and control groups, respectively. There were no significant differences in the patient backgrounds between the groups, except for the reason for incomplete colonoscopy (p = 0.048). The cecal intubation rate was 78.9% (15/19 procedures) and 92.1% (35/38 procedures) in the SIF and control groups, respectively. This study revealed the real-world experience and feasibility of rescue colonoscopy using SIF-H290S, which could be a potential rescue device option after incomplete colonoscopy.

A novel sphincterotome facilitates endoscopic sphincterotomy in patients with Roux-en-Y gastrectomy.

Endoscopic retrograde cholangiopancreatography (ERCP) using a short-type single-balloon enteroscope (short SBE) (SIF-H290; Olympus Medical Systems, Tokyo, Japan), with a working length of 152 cm and a working channel diameter of 3.2 mm, has been reported to be effective in patients with surgically altered anatomy (SAA) [1] [2] [3]. However, endoscopic sphincterotomy (ES) in such patients is challenging, as the appearance of the papilla is inverted and the position is frequently tangential, which makes visualizing the correct incision direction difficult. Despite the effectiveness of reported devices, they do not always achieve the correct incision direction [4] [5].

Direct Insertion of a Short-Type Single-Balloon Enteroscope and Using a Stent Retriever to Treat Difficult Bile Duct Stones in Surgically Altered Anatomy.

Direct Insertion of a Short-Type Single-Balloon Enteroscope and Using a Stent Retriever to Treat Difficult Bile Duct Stones in Surgically Altered Anatomy.

Biliary Cannulation in Patients with Roux-en-Y Gastrectomy: An Analysis of the Factors Associated with Successful Cannulation

Objective We investigated the results of biliary cannulation using a short-type single-balloon enteroscope in patients with a native papilla who had previously undergone Roux-en-Y gastrectomy and analyzed the factors associated with successful cannulation. Methods The study subjects consisted of patients with a native papilla who had previously undergone Roux-en-Y gastrectomy and endoscopic retrograde cholangiopancreatography using a short-type single-balloon enteroscope at our institution between September 2011 and July 2019. We carried out a retrospective investigation of the outcomes, including assessing the success rate of biliary cannulation, and analyzed the factors associated with successful cannulation. Results In total, 78 patients underwent biliary cannulation of a native papilla. The success rate of biliary cannulation was 80.8% (88.5% when including success on repeated attempts). The success rate of the standard cannulation technique was 60.3%, with the use of advanced cannulation techniques to secure the pancreatic duct providing the same additional effect as a normal anatomy. Adverse events occurred in 9.0% of cases. A multivariate analysis of the Roux-en-Y gastrectomy patients found that cannulation was more likely to be successful in patients in whom the scope could be placed in the retroflex position (odds ratio: 7.88, 95% confidence interval: 2.19-37.77, p＜0.001). Conclusion Selective biliary cannulation using a short-type single-balloon enteroscope in patients with a native papilla who had undergone Roux-en-Y gastrectomy was effective and safe. The retroflex position provided a good papilla field of view and improved the success rate of biliary cannulation.

Failure Factors to Reach the Blind End Using a Short-Type Single-Balloon Enteroscope for ERCP with Roux-en-Y Reconstruction: A Multicenter Retrospective Study.

Background Failure factors in reaching the blind end (papillae of Vater, bilioenteric anastomosis) during short-type single-balloon enteroscope-assisted endoscopic retrograde cholangiopancreatography (sSBE-assisted ERCP) in patients with Roux-en-Y (R-Y) reconstruction remain to be evaluated. Aims We investigated the failure factors in such patients. Methods We retrospectively studied 253 initial sessions of sSBE-assisted ERCP at three endoscopy centers from April 2008 through September 2017, examining failure factors and complications associated with scope insertion in patients with R-Y reconstruction. Results R-Y reconstruction was performed in 157 patients (with gastrectomy: 122 patients; without gastrectomy plus bilioenteric anastomosis: 35 patients). R-Y without gastrectomy (p = 0.001; odds ratio (OR), 5.73; 95% confidence interval (CI), 2.07 to 16.01) and the presence of peritoneal dissemination (p = 0.021; OR, 4.71; 95% CI, 1.27 to 17.54) were significant failure factors. Insufficient sSBE length was the cause of failure in 17 (11%) of the 157 patients, and 13 (76%) of the 17 patients were with R-Y without gastrectomy. In cases of insufficient short-type length, using a long-type SBE significantly increased the success rate (p = 0.002). Gastrointestinal stenosis was a significant failure factor (p = 0.011) in patients with peritoneal dissemination. Perforation occurred in 2 patients who responded to conservative treatment. Conclusions Failure factors during sSBE-assisted ERCP were R-Y without gastrectomy and the presence of peritoneal dissemination.

Analysis of the factors involved in procedural failure: Endoscopic retrograde cholangiopancreatography using a short-type single-balloon enteroscope for patients with surgically altered gastrointestinal anatomy.

To analyze factors involved in procedural failure and to discuss responses to procedural failure by using the outcomes of endoscopic retrograde cholangiopancreatography (ERCP) carried out using a short-type single-balloon enteroscope (short SBE) in patients with surgically altered gastrointestinal anatomy. The study sample included patients who underwent ERCP-related procedures using a short SBE between September 2011 and September 2018 at our hospital. Outcomes, including procedural success rate, were studied retrospectively to analyze the factors involved in procedural failure. Analysis included 191 procedures carried out in 121 patients. Procedural success rate was 85.9% with an adverse event rate of 8.4%. Causes of procedural failure included malignant biliary obstruction (odds ratio [OR] 2.89, 95% confidence interval [CI] 1.19-7.25, P=0.02), first ERCP attempt (OR: 5.32, 95% CI: 1.30-36.30, P=0.02), and Roux-en-Y reconstruction (OR: 0.08, 95% CI: 0.004-0.39, P<0.001). With regard to the response to failure, in cases of malignant biliary obstruction, reattempted short SBE-assisted ERCP was difficult because of invasion of the small intestine or papilla. A large number of these cases required alternative treatment (10 of 15 cases, 66.7%) using percutaneous transhepatic biliary drainage (PTBD) or endoscopic ultrasound-guided biliary drainage (EUS-BD). Endoscopic retrograde cholangiopancreatography using a short SBE is safe and effective, with malignant biliary obstruction being a specific cause of failure. Technical proficiency with different modalities, such as PTBD and EUS-BD, is necessary to respond to failure in these cases.

Usefulness of the “newly designed” short-type single-balloon enteroscope for ERCP in patients with Roux-en-Y gastrectomy: a pilot study

Background and aims In recent years, the short single-balloon enteroscope (SBE) has been used during endoscopic retrograde cholangiopancreatography (ERCP) for patients with surgically altered anatomy and has been reported to be useful. However, difficulties remain, and the procedures and devices need improvements. We assessed the usefulness and superiority of a new short SBE equipped with passive bending and high-force transmission by comparisons with outcomes using the conventional short SBE. Methods This study evaluated short SBE-assisted ERCP-related procedures for Roux-en-Y gastrectomy between September 2011 and October 2017. Outcomes including the procedural success rate, which was the primary outcome, were assessed to compare the conventional short SBE (SIF-Y0004 [prototype]) and the new short SBE (SIF-H290S). Results Of 74 procedures performed in 61 patients, 51 procedures in 39 patients involved the SIF-Y0004, and 23 procedures in 22 patients involved the SIF-H290S. The procedural success rates were 70.6 % for SIF-Y0004, and 95.7 % for SIF-H290S, representing better results for the new short SBE ( P = 0.02). The new short SBE also had a superior diagnostic success rate ( P = 0.047) and median time to reach the blind end ( P < 0.001). Conclusions Roux-en-Y gastrectomy patients treated with the new short SBE had better outcomes than those treated with conventional short SBE. More cases need to be studied; however, the new short SBE has the potential to improve ERCP outcomes in patients with surgically altered anatomy.

術後再建腸管に対するstandard typeとshort typeシングルバルーン内視鏡を用いて施行した胆道処置の治療成績に関する検討

術後再建腸管に対するstandard typeとshort typeシングルバルーン内視鏡を用いて施行した胆道処置の治療成績に関する検討

Sa1439 To Evaluate of Comparison Between Short-Type Single-Balloon and Double-Balloon Enteroscope Assisted Ercp in Postsurgical Altered Anatomy

Sa1439 To Evaluate of Comparison Between Short-Type Single-Balloon and Double-Balloon Enteroscope Assisted Ercp in Postsurgical Altered Anatomy

Successful removal of a surgical clip eroded into the hepaticojejunostomy site by use of a short-type single-balloon enteroscope.

Successful removal of a surgical clip eroded into the hepaticojejunostomy site by use of a short-type single-balloon enteroscope.

Short-type single-balloon enteroscope-assisted ERCP in postsurgical altered anatomy: potential factors affecting procedural failure.

Background and study aims Short-type single-balloon enteroscope (short SBE)-assisted endoscopic retrograde cholangiopancreatography (ERCP) is a promising alternative treatment in postsurgical altered anatomy. However, it is technically demanding, and factors affecting its technical difficulty have not yet been clarified. This study aimed to examine the procedural success rate of short SBE-assisted ERCP and the potential factors affecting procedural failure. Patients and methods A total of 117 consecutive patients (203 procedures) with surgically altered anatomy underwent ERCP using prototype short SBEs. The procedural success rate of short SBE-assisted ERCP and the potential factors affecting procedural failure were examined retrospectively. Results The enteroscopy success rate and procedural success rate were 92.6 % (95 % confidence interval [CI] 88.1 % - 95.8 %) and 81.8 % (95 %CI 75.8 % - 86.8 %), respectively. Multivariate analyses indicated that pancreatic indication (odds ratio [OR] 4.35, 95 %CI 1.67 - 11.4), first ERCP attempt (OR 6.03, 95 %CI 2.17 - 16.8), and no transparent hood (OR 4.61, 95 %CI 1.48 - 14.3) were potential risk factors for procedural failure. Conclusions Short SBE-assisted ERCP was effective in postsurgical altered anatomy. This large case series suggested the potential factors affecting procedural failure.

Through-the-scope enteral metal stent placement using a short-type single-balloon enteroscope for malignant surgically reconstructed jejunal stenosis (with video).

Self-expandable metal stent (SEMS) placement in surgically reconstructed intestine is technically challenging, and only a few reports have been published.1, 2 Here, we describe a case of successful SEMS placement for surgically reconstructed jejunal stenosis using a newly developed short-type single-balloon enteroscope (sSBE). A 70-year-old man presented to our hospital with fever and jaundice. Six months earlier, he had undergone subtotal stomach-preserving pancreatoduodenectomy with PD-II reconstruction for duodenal cancer. Computed tomography revealed a dilated intrahepatic bile duct as a result of stenosis in the surgically reconstructed jejunal loop caused by cancer recurrence (Fig. 1a). We could reach the stenosis using a sSBE (SIF-H290S; channel diameter, 3.2 mm; Olympus, Tokyo, Japan); however, it was impossible to pass beyond the stenosis (Fig. 1b). Because of the advanced stage of cancer, palliative through-the-scope (TTS) SEMS placement was attempted. A 0.035-inch guidewire was advanced beyond the stenosis, and an uncovered SEMS (18-mm wide, 80-mm long; Niti-S Enteral Colonic Stent; Taewoong Medical, Gimpo, Korea) was deployed (Fig. 2, Video S1). The postoperative period was uneventful. Jaundice and cholangitis resolved in a few days. Abdominal X-ray revealed that the stent was well expanded. The sSBE is compatible with the use of various interventional devices through its large working channel. To date, there is only one report on TTS SEMS placement, but it used a short-type double-balloon enteroscope (DBE).3 In comparison with DBE, SBE was assumed to be more disadvantageous in carrying out deep insertion.4 Having been equipped with a passive bending part, the sSBE has an increased endoscope flexibility. A recent article using sSBE showed its success rate of insertion to the blind end to be 92%.5 Although the safety of SEMS placement in the jejunum is yet to be established, TTS SEMS placement using sSBE could be an effective, minimally invasive treatment option for patients with advanced cancer. Authors declare no conflicts of interest for this article. Please note: The publisher is not responsible for the content or functionality of any supporting information supplied by the authors. Any queries (other than missing content) should be directed to the corresponding author for the article.

A Case Series: Outcomes of Endoscopic Biliary Self-Expandable Metal Stent for Malignant Biliary Obstruction with Surgically Altered Anatomy.

Few studies have reported the outcomes of self-expandable metal stent (SEMS) placement for malignant biliary obstruction in patients with surgically altered anatomy. To evaluate the outcomes of biliary metal stent placement with the use of a short-type single-balloon enteroscope (working length, 1520mm; channel diameter, 3.2mm) in such patients. We retrospectively studied 13 malignant biliary obstructions treated by SEMS placement. Technical success rate, functional success rate, time to recurrent biliary obstruction (RBO), and complications were evaluated. Technical success rate was 100% (13/13), functional success rate was 92% (12/13), and the median time to RBO was 247days (95% CI 205.6-285.5). Complications comprised mild pancreatitis in one patient. Uncovered SEMSs were placed in three obstructions, partially covered SEMS in five obstructions, and fully covered SEMSs in five obstructions. Three stents occluded (two ingrowths and one mucosal hyperplasia), and one symptomatic distal stent migration occurred after more than 30days from placement. A short-type single-balloon enteroscope was useful for the placement of various SEMS in this patient population with satisfactory outcomes.

Endoscopic retrieval of a proximally migrated biliary stent after pancreaticoduodenectomy by use of a short-type single-balloon enteroscope

Endoscopic retrieval of a proximally migrated biliary stent after pancreaticoduodenectomy by use of a short-type single-balloon enteroscope

Clinical usefulness of a short‐type, prototype single‐balloon enteroscope for endoscopic retrograde cholangiopancreatography in patients with altered gastrointestinal anatomy: Preliminary experiences

A limited number of endoscopic retrograde cholangiopancreatography (ERCP) accessories are compatible with the conventional single-balloon enteroscope (SBE) because of the latter's dimensions. The aim of the present study was to assess the utility of a prototype SBE that has a shorter working length and a wider channel than the conventional SBE. ERCP procedures carried out between January 2012 and July 2013 using the short SBE prototype were reconstructions such as Billroth II (B-II), post-gastrectomy with Roux-en-Y (RY-G), and post-choledochojejunostomy with Roux-en-Y (RY-CJ). We retrospectively analyzed the rate of reaching the blind end of the intestine, the diagnostic success rate, the interventional success rate, and the frequency of related complications. Twenty-seven ERCP procedures on 18 patients analyzed comprised two B-II, 15 RY-G, and 10 RY-CJ reconstructions. With a mean procedure time of 56 min (range 40-150 min), the rate of reaching the blind end, the diagnostic success rate, and the interventional success rate were 24/27 (89%), 20/27 (74%), and 19/27 (70%), respectively. There were no major ERCP-related complications in any patient. The prototype short-type SBE appears safe and effective for use in ERCP, and is compatible with conventional endoscopy accessories.

Endoscopic retrograde cholangiopancreatography in patients with surgically altered anatomy using balloon-assisted enteroscope.

Endoscopic retrograde cholangiopancreatography (ERCP) in patients with surgically altered anatomy involves challenging procedures for ERCP endoscopists. In these patients, the anatomical structure of the intestine is substantially altered, and an endoscope needs to be inserted into the long afferent limb. Moreover, the papilla is observed in the opposite view from the normal anatomy. Recently, a balloon-assisted enteroscope (BAE) has been developed and made available for use in daily practice. The two types of BAE are single-balloon enteroscope (SBE), which is inserted with one balloon attached to the overtube using a balloon-assisted method, and double-balloon enteroscope (DBE), which is inserted with two balloons, one attached to the overtube and the other attached to the tip of the enteroscope. In addition, short-type DBE (short-DBE) and short-type SBE (short-SBE) with a working length of approximately 150 cm, which could be used with various ERCP accessories, are commercially available or under development. Notably, the success rate of ERCP through coordinated manipulation with a balloon was remarkably improved with the use of BAE, even in patients with surgically altered anatomy. Here, we report the current status and procedures of ERCP in patients with surgically altered anatomy.