Abstract
Background and aims
To investigate the effectiveness of double-balloon enteroscope-assisted retrograde
cholangiopancreatography (DBE-ERCP) in patients with gastrointestinal surgically altered
anatomy (SAA).
Methods
From May 2013 to October 2021, all consecutive patients undergoing DBE-ERCP in three
gastroenterological referral centers in Northern Italy were enrolled in the study.
Patients were assessed regarding their medical history, previous surgery, time from
previous surgery to the DBE-ERCP procedure, and the success or failure of DBE-ERCP.
Results
Fifty-three patients (60% men, median age 65 (23–89) years) undergoing 67 DBE-ERCP
procedures (1–3 DBE-ERCP per patient) were enrolled. Reasons for SAA included orthotopic
liver transplantation (23%), ulcers (15%), malignancies (43%), difficult cholecystectomy
(17%), and other causes (2%). Types of surgery included Roux-en-Y biliodigestive anastomosis
(45%), Roux-en-Y gastrectomy (32%), pancreaticoduodenectomy (17%), and Billroth II
gastrectomy (6%). The overall DBE-ERCP success rate was 86%. The type of surgery,
indications, and the length of time between previous surgery and DBE-ERCP were not
statistically associated with DBE-ERCP success. The DBE-ERCP success rate increased
from 2018 to 2021.
Conclusions
DBE-ERCP is a successful procedure in challenging patients with SAA. The improvement
in results over time indicates the necessity of adequate training and of centralizing
patients in referral centers.
Keywords
Abbreviations:
B2 (Billroth II), DBE (double-balloon endoscopy), ERCP (endoscopic retrograde cholangiopancreatography), OLT (orthotopic liver transplantation), PD (pancreatoduodenectomy), RY (Roux-en-Y), RYGB (Roux-en-Y gastric bypass), RYHJ (Roux-en-Y hepaticojejunostomy), PTBD (percutaneous transhepatic biliary drainage)To read this article in full you will need to make a payment
Purchase one-time access:
Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online accessOne-time access price info
- For academic or personal research use, select 'Academic and Personal'
- For corporate R&D use, select 'Corporate R&D Professionals'
Subscribe:
Subscribe to Digestive and Liver DiseaseAlready a print subscriber? Claim online access
Already an online subscriber? Sign in
Register: Create an account
Institutional Access: Sign in to ScienceDirect
References
- Predictors of success for double balloon-assisted endoscopic retrograde cholangiopancreatography in patients with Roux-en-Y anastomosis.Dig Endosc. 2017; 29: 190-197https://doi.org/10.1111/DEN.12739
- Recent advances of interventional endoscopic retrograde cholangiopancreatography and endoscopic ultrasound for patients with surgically altered anatomy.J Clin Med. 2021; 10: 1624https://doi.org/10.3390/JCM10081624
- Indications and techniques of biliary drainage for acute cholangitis in updated Tokyo Guidelines 2018.J Hepatobiliary Pancreat Sci. 2017; 24: 537-549https://doi.org/10.1002/JHBP.496
- Techniques for performing ERCP in Roux-en-Y gastric bypass patients.Gastroenterol Hepatol. 2012; 8 (N Y)PMCID: PMC3424474: 390-392
- Double balloon enteroscopy: a useful tool for diagnostic and therapeutic procedures in the pancreaticobiliary system.Am J Gastroenterol. 2008; 103: 894-900https://doi.org/10.1111/J.1572-0241.2007.01745.X
- Laparoscopy-assisted versus balloon enteroscopy-assisted ERCP in bariatric post-Roux-en-Y gastric bypass patients.Gastrointest Endosc. 2012; 75: 748-756https://doi.org/10.1016/J.GIE.2011.11.019
- ERCP via gastrostomy vs. double balloon enteroscopy in patients with prior bariatric Roux-en-Y gastric bypass surgery.Surg Endosc. 2013; 27: 2894-2899https://doi.org/10.1007/S00464-013-2850-6
- Double-balloon ERCP in patients who have undergone Roux-en-Y surgery: a case series.Gastrointest Endosc. 2007; 66: 1038-1041https://doi.org/10.1016/J.GIE.2007.06.056
- Double-balloon enteroscopy for endoscopic retrograde cholangiography in patients with a Roux-en-Y anastomosis.Endoscopy. 2007; 39: 1068-1071https://doi.org/10.1055/S-2007-966841
- A multicenter, U.S. experience of single-balloon, double-balloon, and rotational overtube-assisted enteroscopy ERCP in patients with surgically altered pancreaticobiliary anatomy (with video).Gastrointest Endosc. 2013; 77: 593-600https://doi.org/10.1016/J.GIE.2012.10.015
- Double balloon enteroscopy-assisted endoscopic retrograde cholangiopancreatography in Roux-en-Y gastric bypass anatomy: expert vs. novice experience.Endosc Int Open. 2018; 6: E885https://doi.org/10.1055/A-0599-6059
- Double-balloon enteroscopy for diagnostic and therapeutic ERCP in patients with surgically altered gastrointestinal anatomy: a systematic review and meta-analysis.Surg Endosc. 2021; 35: 18-36https://doi.org/10.1007/S00464-020-07893-X
- ERCP in patients with long-limb Roux-en-Y gastrojejunostomy and intact papilla.Gastrointest Endosc. 2002; 56: 225-232https://doi.org/10.1016/S0016-5107(02)70182-X
- Laparoscopy-assisted ERCP after biliopancreatic diversion.Obes Surg. 2007; 17: 251-254https://doi.org/10.1007/S11695-007-9026-1
- Endoscopic ultrasound-guided duodenojejunal anastomosis to treat postsurgical Roux-en-Y hepaticojejunostomy stricture: a dream or a reality?.Endoscopy. 2015; 47: E350-E351https://doi.org/10.1055/s-0034-1392424
- Endoscopic entero-enteral bypass: an effective new approach to the treatment of postsurgical complication of hepaticojejunostomy.Endoscopy. 2019; 51: 1146-1150https://doi.org/10.1055/a-0914-2855
- Endoscopic biliary drainage for malignant distal biliary obstruction: which is better - endoscopic retrograde cholangiopancreatography or endoscopic ultrasound?.Dig Endosc. 2022; 34: 317-324https://doi.org/10.1111/den.14186
- Endoscopic ultrasound-guided antegrade procedures for managing bile duct stones in patients with surgically altered anatomy: comparison with double-balloon enteroscopy-assisted endoscopic retrograde cholangiography (with video).Dig Endosc. 2021; 33: 1179-1187https://doi.org/10.1111/den.13927
- Endoscopic retrograde cholangiopancreatography using short-type double-balloon enteroscope: experience in Hong Kong.J Dig Dis. 2021; 22: 545-550https://doi.org/10.1111/1751-2980.13040
- A case of successful enteroscopic balloon dilation for late anastomotic stricture of choledochojejunostomy after living donor liver transplantation.Liver Transpl. 2005; 11: 1608-1610https://doi.org/10.1002/LT.20623
- A lexicon for endoscopic adverse events: report of an ASGE workshop.Gastrointest Endosc. 2010; 71: 446-454https://doi.org/10.1016/J.GIE.2009.10.027
- Short' double-balloon enteroscope for endoscopic retrograde cholangiopancreatography in patients with a surgically altered upper gastrointestinal tract.Can J Gastroenterol. 2011; 25: 615-619https://doi.org/10.1155/2011/354546
- Long- and short-type double-balloon enteroscopy-assisted therapeutic ERCP for intact papilla in patients with a Roux-en-Y anastomosis.Surg Endosc. 2011; 25: 713-721https://doi.org/10.1007/S00464-010-1226-4
- Effective “short” double-balloon enteroscope for diagnostic and therapeutic ERCP in patients with altered gastrointestinal anatomy: a large case series.Endoscopy. 2009; 41: 849-854https://doi.org/10.1055/S-0029-1215108
- ERCP using a short double-balloon enteroscope in patients with prior pancreatoduodenectomy: higher maneuverability supplied by the efferent-limb route.Surg Endosc. 2015; 29: 1944-1951https://doi.org/10.1007/S00464-014-3889-8
- Double-balloon enteroscopy for ERCP in patients with Billroth II anatomy: results of a large series of papillary large-balloon dilation for biliary stone removal.Endosc Int Open. 2015; 3: E216-E222https://doi.org/10.1055/S-0034-1391480
- Japanese DB-ERC Study Group. Diagnostic and therapeutic endoscopic retrograde cholangiography using a short-type double-balloon endoscope in patients with altered gastrointestinal anatomy: a multicenter prospective study in Japan.Am J Gastroenterol. 2016; 111: 1750-1758https://doi.org/10.1038/AJG.2016.420
- Potential factors affecting results of short-type double-balloon endoscope-assisted endoscopic retrograde cholangiopancreatography.Dig Dis Sci. 2020; 65: 1460-1470https://doi.org/10.1007/S10620-019-05857-3
- Utility of the short double-balloon enteroscope to perform pancreaticobiliary interventions in patients with surgically altered anatomy in a US multicenter study.Dig Dis Sci. 2013; 58: 858-864https://doi.org/10.1007/S10620-012-2385-Z
- ERCP with the overtube-assisted enteroscopy technique: a systematic review.Endoscopy. 2014; 46: 560-572https://doi.org/10.1055/S-0034-1365698
- What is the learning curve associated with double-balloon enteroscopy? Technical details and early experience in 6U.S. tertiary care centers.Gastrointest Endosc. 2006; 64: 740-750https://doi.org/10.1016/J.GIE.2006.05.022
- Efficacy and safety of device-assisted enteroscopy ERCP in liver transplantation: a systematic review and meta-analysis.Clin Tranplant. 2020; 34: e13864https://doi.org/10.1111/ctr.13864
Article info
Publication history
Published online: November 12, 2022
Accepted:
October 21,
2022
Received:
July 3,
2022
Publication stage
In Press Corrected ProofFootnotes
Financial support statement: nothing to disclose.
Data availability statement: Data from the present study are confidential but can be provided upon direct request to the authors.
Identification
Copyright
© 2022 Editrice Gastroenterologica Italiana S.r.l. Published by Elsevier Ltd. All rights reserved.
