Through-the-scope self-expanding metal stent placement using newly developed short doubleballoon endoscope for the effective management of malignant afferent-loop obstruction This is the first report of through-thescope (TTS) self-expanding metal stent (SEMS) placement, using a newly developed, short-type, double-balloon endoscope (S-DBE), for the palliation of malignant afferent-loop obstruction (ALO). The endoscope has a 3.2 mm working channel and 152 cm working length (EI-580BT; Fujifilm, Tokyo, Japan). The SEMS is a new Niti-S D pyloric/duodenal uncovered stent, with a diameter of 18 mm and lengths of 6 cm, 8 cm, 10 cm, or 12 cm, which is deployed using a 9 Fr × 220 cm

The N-short DBE for ERC in postoperative patients is useful and safe. DB-ERC is promising therapeutic modality in such patients and should be selected as the first-line policy.

Background and AimEndoscopic retrograde cholangiopancreatography (ERCP) using balloon‐assisted endoscope such as double‐balloon endoscope is even effective for patients with surgically altered anatomy. Yet comprehensive studies on complications of ERCP using balloon‐assisted endoscope have not been made. We analyzed the characteristics and the causes of complications of ERCP using double‐balloon endoscope (DB‐ERCP) procedures and aimed to suggest effective managements.MethodsA total of 1576 procedures of DB‐ERCP in 714 patients with surgically altered gastrointestinal anatomy in our hospital were evaluated retrospectively using a statistic analysis.ResultsThe overall complication occurrence rate was 5.8%. By type of complications are perforation 3.2%, mucosal laceration 0.5%, hemorrhage 1.0%, pancreatitis 0.6%, respiratory disorder 0.4%, and others 0.2%. By type of surgical reconstruction methods were Roux‐en‐Y reconstruction with choledocho‐jejunal anastomosis 4.2%, Roux‐en‐Y reconstruction without choledocho‐jejunal anastomosis 6.7%, pancreaticoduodenectomy 4.5%, pylorus preserving pancreaticoduodenectomy 4.2%, Billroth II gastrectomy (B‐II) 11.6%, and other reconstruction method (others) 7.4%. The contributing factors calculated by a multivariate analysis were B‐II (odds ratio: 1.864, 95% confidence interval: 1.001–3.471, P = 0.050) and the presence of naïve papilla (odds ratio: 3.268, 95% confidence interval: 1.426–7.490, P = 0.005).ConclusionsDB‐ERCP is a safe method with a total complication rate of 5.8% that could be considered within an acceptable range. The most common complication was the injury of the digestive tract such as perforation. Affecting risk factors for complications were B‐II and the presence of naïve papilla. DB‐ERCP procedures should be performed carefully of these factors.

The endoscopic approach for biliary diseases in patients with surgically altered gastrointestinal anatomy (SAGA) had been generally deemed impractical. However, it was radically made feasible by the introduction of double balloon endoscopy (DBE) that was originally developed for diagnosis and treatments for small-bowel diseases. Followed by the subsequent development of single-balloon endoscopy (SBE) and spiral endoscopy (SE), interventions using several endoscopes for biliary disease in patients with SAGA widely gained an acceptance as a new modality. Many studies have been made on this new technique. Yet, some problems are to be solved. For instance, the mutual unavailability among devices due to different working lengths and channels, and unestablished standardization of procedural techniques can be raised. Additionally, in an attempt to standardize endoscopic procedures, it is important to evaluate biliary cannulating methods by case with existence of papilla or not. A full comprehension of the features of respective scope types is also required. However there are not many papers written as a review. In our manuscript, we would like to evaluate and make a review of the present status of diagnostic and therapeutic endoscopic retrograde cholangiopancreatography applying DBE, SBE and SE for biliary diseases in patients with SAGA for establishment of these modalities as a new technology and further improvement of the scopes and devices.

Endoscopic retrograde cholangiopancreatography (ERCP) is an endoscopic modality established for diagnosis and treatment of pancreaticobiliary diseases. However ERCP in patients with surgically altered anatomy (SAA) has been difficult, and more invasive therapies have been primarily selected. The development of balloon assisted endoscopes (BAEs) innovatively facilitated ERCP in such patients. Recent advances of BAEs and other devices greatly contributed to increasing success of ERCP using BAEs (BAE‐ERCP). Furthermore, interventions using Endoscopic Ultrasound (EUS‐intervention) have been reported to be useful for pancreaticobiliary diseases in patients with SAA, which provide more options for endoscopic therapies and are also expected as a rescue therapy for difficult cases of BAE‐ERCP. In order to thoroughly complete endoscopic treatment for pancreaticobiliary diseases with SAA, it is important to standardize the BAE‐ERCP procedures based on the features of respective endoscopes and to establish a strategy for endoscopic treatment which includes analysis of BAE‐ERCP difficult cases and selection of cases for rescue therapy. In addition, it is essential to be acquainted with the characteristics of possible adverse events of the procedure and to be able to deal with them for safe accomplishment of endoscopic treatment.