Direct cholangioscopy combined with double-balloon enteroscope-assisted endoscopic retrograde cholangiopancreatography

Abstract

Double-balloon enteroscope (DBE)-assisted endoscopic retrograde cholangiopancreatography (ERCP) is an effective endoscopic approach for pancreatobiliary disorders in patients with altered gastrointestinal anatomy. Endoscopic interventions via DBE in these postoperative settings remain difficult because of the lack of an elevator and the use of extra-long ERCP accessories. Here, we report the usefulness of direct cholangioscopy with an ultra-slim gastroscope during DBE-assisted ERCP. Three patients with choledocholithiasis in postoperative settings (two patients after Billroth II gastrojejunostomy and one patient after Roux-en-Y gastrojejunostomy) were treated. DBE was used to gain access to the papilla under carbon dioxide insufflation, and endoscopic sphincterotomy was performed with a conventional sphincterotome. For direct cholangioscopy, the enteroscope was exchanged for an ultra-slim gastroscope through an incision in the overtube, which was inserted directly into the bile duct. Direct cholangioscopy was used to extract retained bile duct stones in two cases and to confirm the complete clearance of stones in one case. Bile duct stones were eliminated with a 5-Fr basket catheter under direct visual control. No adverse events were noted in any of the three cases. Direct cholangioscopy with an ultra-slim gastroscope facilitates subsequent treatment within the bile duct. This procedure represents another potential option during DBE-assisted ERCP.

Review article: Asia‐Pacific consensus recommendations on endoscopic tissue acquisition for biliary strictures

“…A retrospective study of 177 patients with hilar biliary strictures revealed that percutaneous transhepatic cholangioscopy ‐guided biopsy had a sensitivity of 76.8% for differential diagnosis of hilar strictures . Balloon‐assisted ERCP has been reported successful in case studies in patients with surgically altered gastrointestinal anatomy . If available, cholangioscopy or fluoroscopy‐guided probe‐based confocal laser endomicroscopy can be added as a complementary test before tissue sampling for virtual diagnosis as well as for directing a targeted biopsy.…”

Mide, duodenum ve safra yollarına erişimden ödün vermeden, seçilmiş hastalarda etkili kilo kaybını sağlayan bir yöntem: Vertikal bantlı gastroplasti – Roux-en-Y gastrojejunostomi

“…In 1998, Baron and Vickers described the creation of surgical gastrostomy to access the gastric remnant [14]. Later, a double balloon was introduced as a new endoscopic technique to allow examination of the entire small bowel [15]. In a recent report [16], percutaneous endoscopic gastrostomy with immediate self-expandable metal stent placement allowed antegrade transgastric ERCP during the same procedure.…”

Multiple Cancers of the Biliary Tract and Pancreatic Duct after Cholecystectomy for Gallbladder Cancer in a Patient with Pancreaticobiliary Maljunction

“…Therefore, we have not been able to successfully perform DBE-DCS in every patient. In difficult cases of DBE-DCS, switching from DBE to an ultraslim endoscope is useful to allow DCS to be performed (17,18). DBE-DCS can potentially cause adverse events, such as perforation, bleeding, and cholangitis.…”