Double-balloon endoscopy-assisted treatment of hepaticojejunostomy anastomotic strictures and predictive factors for treatment success

Shimoda, Tatsuya; Kogure, Hirofumi; Nakai, Yousuke; Ishigaki, Kazunaga; Hakuta, Ryunosuke; Saito, Kei; Saito, Tomotaka; Takahara, Naminatsu; Hamada, Tsuyoshi; Mizuno, Suguru; Yamada, Atsuo; Tada, Minoru; Isayama, Hiroyuki; Koike, Kazuhiko

doi:10.1007/s00464-019-06924-6

Cited by 41 publications

(56 citation statements)

References 29 publications

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“…From our point of view, cannulation and visualization of the biliary tree with DBE in patients with a hepaticojejunostomy can be performed more easily with a CRE balloon. This method is similar to the conventional papillotomy technique in patients with normal anatomy and seems to be less dangerous [27,33]. CRE balloons are marketed in different diameters and at the time of our study, 5 to 8-F prostheses can be advanced throughout the 2.8-mm diameter working channel of the therapeutic DBE.…”

Section: Discussionmentioning

confidence: 90%

“…The risk of complications during DBE-ERCP seems to be lower than that of PTC procedures, which is around 5%, while therapeutic actions (balloon dilatation, biliary stent installation, or biliary stone therapy) have been performed successfully [30]. Thus, DBE-ERCP has an important capacity to manage benign or malign hepatobiliary and ampullary pathologies, even in patients who have history of small bowel surgery, and it can help to decrease the number of percutaneous procedures [3,32,33]. Our study confirmed that successful DBE-ERCP with a biliary drainage process led to a considerable decrease of cholestasis or cholangitis in 27 patients (87.1%) and it was possible to avoid of PTC in these 27 patients.…”

Section: Discussionmentioning

confidence: 99%

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Double Balloon Enteroscopy Improves ERCP Successfulness in Patients with Modified Small Bowel Anatomy

Şirin

Hülagü

2020

North Clin Istanbul

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Cite this article as: Sirin G, Hulagu S. Double balloon enteroscopy improves ERCP success in patients with modified small bowel anatomy. North Clin Istanb 2020;7(2):131-139. E ndoscopic retrograde cholangiopancreatography (ERCP) is a very useful procedure in the management of hepatobiliary system and pancreatic diseases. Although ERCP has been performed successfully in 85% to 95% of patients with normal small bowel anatomy [1], the success is lower in patients who have undergone a Billroth II (BII) gastrojejunostomy, and particularly in patients with a Roux-en-Y (R-en-Y) reconstruction with a long afferent limb (62-92%) [2][3][4]. Implementation of this kind of reconstruction is common after ortho-ABSTRACT OBJECTIVE: The aim of this study was to evaluate the effect of double-balloon enteroscopy (DBE) on the success of endoscopic retrograde cholangiopancreatography (ERCP) procedures in patients with surgically modified gastrointestinal (GI) tract anatomy. METHODS:The medical records of patients who underwent ERCP in the were examined. From the patient group that was scheduled to undergo DBE-ERCP, the details of cases in which ERCP via standard duodenoscope or DBE-ERCP was performed during the same session because standard ERCP failed were included. Procedure parameters, outcomes, and complications related to the procedure in both groups were analyzed. Patients who underwent the DBE-ERCP procedure directly, those who underwent push enteroscopy, or gastroscopy to evaluate the GI tract anatomy before the day of ERCP, and who underwent DBE-ERCP on a day other than the initial ERCP session were excluded. Afferent loop intubation, access to the major papilla, selective cannulation, therapeutic success rates, and the effect of DBE on overall procedure success were evaluated. RESULTS:Fifty-one patients with a history of BII gastrojejunostomy and 11 patients with hepaticojejunostomy (with or without Roux-en-Y) were included in the study. In all patients, the ERCP procedure was initiated with a standard duodenoscope. If intubation of the afferent loop was unsuccessful in reaching the major papilla or enterobiliary anastomosis, DBE was used. In 30 (48.4%) of the 62 patients whose GI tract was anatomically altered, the duodenoscope was successfully advanced to the ampulla and 27 (43.5%) were cannulated successfully. Thirty-one patients underwent DBE-ERCP. DBE reached the ampulla or enterobiliary anastomosis in 30 patients (96.8%) and selective choledocus cannulation was achieved in all patients but 3 (90%), including 1 patient with a hepaticojejunostomy. The overall ERCP success rate increased from 43.5% (27/62) to 87.1% (54/62). Two perforations (1 during standard duodenoscopy and 1 with DBE-ERCP) were observed. CONCLUSION:The overall success rate of ERCP increased with use of the DBE technique in patients with small bowel anatomic variations that were the result of previous surgery.

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Section: Discussionmentioning

confidence: 90%

Section: Discussionmentioning

confidence: 99%

Double Balloon Enteroscopy Improves ERCP Successfulness in Patients with Modified Small Bowel Anatomy

Şirin

Hülagü

2020

North Clin Istanbul

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“…This was a vigorous and time-intensive protocol necessitating monthly visits. There was also a high stricture recurrence in 42%, with a median time to recurrence of 3.4 months, and cholangitis in 10% of cases [36]. A meta-analysis of 15 studies showed overall success rates of 81% for DBE to reach the biliary anastomosis of papilla and 62% for achieving successful biliary intervention [37].…”

Section: Typementioning

confidence: 99%

Benign Biliary Strictures: A Systematic Review on Endoscopic Treatment Options

2020

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Benign biliary strictures can be difficult to manage. Untreated biliary strictures can lead to complications, such as chronic cholestasis, jaundice, recurrent sepsis, and secondary biliary cirrhosis, which can have severe ramifications. The management landscape is constantly evolving, with the development of modifiable self-expandable metal stents and biodegradable stents. This review critically appraises current endoscopic treatment strategies, in particular focusing on the shortfalls, such as stent migration and stricture recurrence. It also proposes a treatment algorithm based on aetiologias and the location of the strictures.

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“…BE-ERCP was performed under moderate sedation with intravenous injection of diazepam or midazolam and pethidine hydrochloride during the procedure, and continuous intravenous administration of dexmedetomidine hydrochloride. The details of BE-ERCP procedures in our institution were reported previously [23,24].…”

Section: Endoscopic Proceduresmentioning

confidence: 99%

Feasibility of balloon endoscope-assisted endoscopic retrograde cholangiopancreatography for the elderly

et al. 2020

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Background and study aims Endoscopic retrograde cholangiopancreatography (ERCP) for patients with surgically altered anatomy is challenging. Recently, balloon endoscopy has been shown to facilitate ERCP for this population with a high technical success rate, but adverse events (AEs) are not uncommon. Compared to non-elderly patients, elderly patients may be at higher risk of AEs due to underlying comorbidities. The current study aimed to evaluate the feasibility of balloon endoscope-assisted ERCP (BE-ERCP) for the elderly. Patients and methods We retrospectively identified patients who underwent BE-ERCP between January 2010 and September 2019. For patients who underwent multiple procedures during the study period, the first session was analyzed. Early AEs associated with BE-ERCP were compared between elderly (≥ 75 years) and non-elderly patients. Results A total of 1,363 BE-ERCP procedures were performed, and 568 patients (211 elderly and 357 non-elderly) were included for the analyses. Technical success rates were high in both the elderly and non-elderly groups (80 % vs. 80 %, respectively). The rates of early AEs were similar between the groups (12 % vs. 9.0 % in the elderly and non-elderly group, respectively; P = 0.31). The mltivariable-adjusted odds ratio for early AEs comparing elderly to non-elderly patients was 1.36 (95 % confidence interval, 0.74–2.51; P = 0.32). Specifically, we did not observe between-group differences in rates of gastrointestinal perforation (2.4 % vs. 2.8 % in elderly and non-elderly groups, respectively; P = 0.99) and aspiration pneumonia (1.9 % vs. 0.6 %, P = 0.20). Conclusions BE-ERCP is a feasible procedure for elderly individuals with surgically altered anatomy.

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Double-balloon endoscopy-assisted treatment of hepaticojejunostomy anastomotic strictures and predictive factors for treatment success

Cited by 41 publications

References 29 publications

Double Balloon Enteroscopy Improves ERCP Successfulness in Patients with Modified Small Bowel Anatomy

Double Balloon Enteroscopy Improves ERCP Successfulness in Patients with Modified Small Bowel Anatomy

Benign Biliary Strictures: A Systematic Review on Endoscopic Treatment Options

Feasibility of balloon endoscope-assisted endoscopic retrograde cholangiopancreatography for the elderly

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