Effectiveness of double-balloon enteroscopy-assisted endoscopic retrograde cholangiopancreatography (DBE-ERCP): A multicenter real-world study

Published:November 12, 2022DOI:


      Background and aims

      To investigate the effectiveness of double-balloon enteroscope-assisted retrograde cholangiopancreatography (DBE-ERCP) in patients with gastrointestinal surgically altered anatomy (SAA).


      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.


      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.


      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.



      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)
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