Double Balloon Endoscope Facilitates Endoscopic Retrograde Cholangiopancreatography in Roux‐en‐y Anastomosis Patients

Abstract

Endoscopic retrograde cholangiopancreatography (ERCP) is the gold standard for the treatment of patients with pancreaticobiliary disorders, but endoscopic therapy is very difficult to carry out in patients with a Roux-en-Y anastomosis. We herein present the results of ERCP for patients with a Roux-en-Y anastomosis using a double-balloon endoscope. Six patients (six men with a mean age of 69 years) who had undergone prior gastric resection with Roux-en-Y reconstruction were enrolled in the present study and underwent ERCP and associated procedures. ERCP was carried out with a double balloon endoscope, which has one balloon attached to the tip of the endoscope and another attached to the distal end of the soft overtube. In all patients, entering the Y loop was successfully accomplished, and the papilla of Vater was also reached in all cases (100%). Cannulation was successful in four patients (66.7%). The final diagnosis was choledocholithiasis in two patients, biliary fistula in one patient and pancreatic cancer in one patient. A needle-knife precut papillotomy was carried out after placement of a bile duct stent in two patients, and injection of N-butyl-2-cyanoacrylate into a biliary fistula was carried out in one patient. None of the patients suffered from any complications. A double balloon endoscope is therefore considered to be useful for carrying out ERCP and associated procedures in patients with a Roux-en-Y anastomosis.

What is the best reconstruction method after distal gastrectomy for gastric cancer?

“…Hitze et al [21] reported that the papilla of Vater was reached in 92% (54/59) of the patients who underwent the B-II procedure compared to only 33% (2/6) of those who underwent R-Y reconstruction. Thus, regarding the selection of reconstructive methods, future endoscopic requirements should always be taken into account despite the development of advanced endoscopic techniques [22].…”

Hybrid Endolaparoscopic Management of Biliary Tract Pathology in Bariatric Patients After Gastric Bypass

“…[10][11][12] According to a recent review, the rate of reaching the papilla of Vater or the bilioenteric anastomosis was 86% to 94%, and the success rate of ERCP was 67% to 89%. 2,7,14,18 After achieving a percutaneous gastrostomy, a posterior ERCP can be planned. In a more recent report, the authors succeeded in entering the Y-loop into the papilla of Vater in all 6 patients who had undergone prior gastric resection with Roux-en-Y reconstruction cases.…”

Ampullary intervention for bile duct stones in patients with surgically altered anatomy

“…Endoscopic retrograde cholangiopancreatography (ERCP) using a standard scope remains technically challenging as a result of the inability to reach the anastomosis. A recently developed single‐/double‐balloon enteroscope makes it possible to carry out therapeutic transpapillary ERCP for such cases . Ampullary intervention for bile duct stones in patients with surgically altered anatomy is discussed herein.…”