Double-balloon ERCP in patients who have undergone Roux-en-Y surgery: a case series

Emmett, Daniel S.; Mallat, Damien

doi:10.1016/j.gie.2007.06.056

Cited by 187 publications

(168 citation statements)

References 8 publications

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“…Though not commonly performed, ERC in gastric bypass anatomy seems also possible with a high probability of success. 45 In conclusion, BE helps greatly to diagnose and treat small bowel disease, and beyond that, offers the opportunity to access the biliary system in Roux-Y surgery. The capability to apply BE should be adopted in every large volume endoscopy center and accessories for BE endoscopes may be provided in these endoscopy departments for possible intervention.…”

Section: Balloon-enteroscopy For Erc In Surgical Modification Of the mentioning

confidence: 97%

Interventional balloon-enteroscopy

Albert¹

2012

jig

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Section: Balloon-enteroscopy For Erc In Surgical Modification Of the mentioning

confidence: 97%

Interventional balloon-enteroscopy

Albert¹

2012

jig

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“…In this context, success rates of papillary or bile anastomosis range 55.0-100.0% in the series described in the literature, with catheterization rates, after reaching, above 90.0% [18][19][20][21][22][23][24][25][26][27][28][29][30][31], no identified significant difference between methods [28]. The high success rates of both papillary reach and bile duct catheterization should be attributed to the fact that most of the patients reported were not carriers of Roux-en-Y made with the purpose of weight loss, thus presenting segments of intestinal loops that make up the Y shorter, when compared to patients after bariatric surgery.…”

Section: Discussionmentioning

confidence: 99%

Approach of the Bile Duct by Gastrostomy in Patients With Bypass in Roux-en-Y Proved to Be Safe and Effective

et al. 2017

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Background: The prevalence and increase of obesity in the world are that 2.3 billion adults were overweight and 700 million adults were obese in 2015. In the context of the morbid obesity pandemic, bariatric surgery was presented as a gold standard treatment. It is known that the prevalence of cholelithiasis is 3 to 4 times higher in morbidly obese patients when compared to the general population. Literature reports that the first attempts to approach the biliary tract in patients with gastric bypass in Roux-en-Y, were performed transorally and had resulted in low success rates. The aim of this study was to analyze the results of the use of the endoscopic transgastrostomy technique for the treatment of biliary tract diseases in patients submitted to Yde-Roux bypass.

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“…DBE-assisted ERCP enables the endoscope to reach the papilla or ductal anastomoses in patients with previous small bowel surgery that would otherwise be challenging with a normal duodenoscope or forward-viewing endoscope ( Figure 2). In one of the first case series by Emmett DS and Mallat DB describing DB-ERCP in 6 patients with Roux-en-Y gastric bypass surgery, the ampulla was successfully reached in 100% of the cases, with adequate cannulation of either the biliary or pancreatic duct in 88% of them [19]. Therapeutic interventions ranged from stone removal to pancreaticobiliary-duct dilation to sphincterotomy.…”

Section: Dbe-ercpmentioning

confidence: 99%

The Role of Overtube-assisted Deep Enteroscopy ERCP in Roux-en-Y Gastric Bypass Patients

Ali¹,

Ahmed²,

Iqbal³

2014

J Obes Weight Loss Ther

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Bariatric surgery is the fastest growing medical intervention for obesity performed in theUS and Roux-en-Y Gastric Bypass (RYGB), is considered the "gold standard"comprising more than 60% of these cases. However, patients with surgically alteredanatomy after undergoing RYGB pose serious challenges to the endoscopist whenaccess to the biliary or pancreatic systems is required. Hurdles include reaching themajor papilla after navigating the length of the roux limb (often >100 cm) given thelimitations of standard gastroscopes and even push enteroscopes in achievingsufficient depth of insertion, orientation (upside-down configuration of the papilla), andthe lack of accessories that are actually designed for the long endoscopes required forperforming ERCPs in this patient population.To work around the aforementioned problems-specifically the length of the Rouxlimb-innovative techniques, notably overtube systems have been developed to allowthe enteroscope to reach the ampulla and perform ERCP. Three overtube-systems arepresently available: Double-balloon Enteroscopy (DBE), Single-balloon Enteroscopy(SBE), and Spiral Enteroscopy (SE). This review is designed to describe the role of these 3overtube systems in assisting with ERCP in RYGB patients based on existing literatureand evaluate their success rates in reaching the ampulla, diagnostic & therapeuticyields, and complication rates.Our review shows good success rates when comparing ability to reach ampulla (DBEERCP:83%; SBE-ERCP: 71%; SE-ERCP: 70%), diagnostic (DBE-ERCP: 77%; SBEERCP:55%; SE-ERCP: 41%) and therapeutic yields (DBE-ERCP: 75%; SBE-ERCP:81%; SE-ERCP: 68%) with low complication rates for all three systems.The sheer volume of RYGB procedures being performed and the associated predictedincrease in complications will lead to advanced endoscopists encountering morepatients with surgically altered anatomy and our review provides evidence thatovertube-assisted systems are effective and safe, and should be considered as a firstline modality in RYGB patients requiring ERCP.

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Double-balloon ERCP in patients who have undergone Roux-en-Y surgery: a case series

Cited by 187 publications

References 8 publications

Interventional balloon-enteroscopy

Interventional balloon-enteroscopy

Approach of the Bile Duct by Gastrostomy in Patients With Bypass in Roux-en-Y Proved to Be Safe and Effective

The Role of Overtube-assisted Deep Enteroscopy ERCP in Roux-en-Y Gastric Bypass Patients

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