Endoscopic Retrograde Cholangiography Using an Anterior Oblique-Viewing Endoscope in Patients with Altered Gastrointestinal Anatomy

Abstract

Background Endoscopic retrograde cholangiopancreatography (ERCP) is technically more challenging in patients who have undergone gastrointestinal (GI) reconstruction.AimsThe aim of this study was to evaluate the utility of the anterior oblique-viewing endoscope (AOE) for ERCP in patients with a retained major duodenal papilla after GI reconstruction.MethodsThis was a retrospective study involving 40 patients (50 procedures) with a retained papilla after GI reconstruction who underwent ERCP using AOE. Reconstruction consisted of Billroth II gastrectomy (BII) in 25 patients (30 procedures) and Roux-en-Y anastomosis (RY) in 15 patients (20 procedures). In RY cases, the long single-balloon enteroscope (LSBE) was exchanged with AOE after reaching the papilla.ResultsThe overall rate of reaching the papilla using AOE was 90.0 % (45/50) [BII; 86.7 % (26/30), RY; 95.0 % (19/20)]. The overall rate of biliary cannulation was 97.8 % (44/45) [BII; 100 % (26/26), RY; 94.7 % (18/19)], and the rate of biliary cannulation for intact papilla was 96.6 % (28/29) [BII; 100 % (14/14), RY; 93.3 % (14/15)]. Treatment success rate in cases of successful biliary cannulation was 97.7 % (43/44) [BII; 100 % (26/26), RY; 94.4 % (17/18)]. The rate of adverse events was 6.0 % (3/50) [BII; 3.3 % (1/30), RY; 10.0 % (2/20)], with mild pancreatitis occurring in 3 cases.ConclusionsHigh biliary cannulation and treatment rates can be achieved during ERCP using AOE in altered GI anatomy cases with a retained papilla, as long as the papilla can be reached. In RY cases, exchanging AOE with LSBE is useful after reaching the papilla.

A Case Series: Outcomes of Endoscopic Biliary Self-Expandable Metal Stent for Malignant Biliary Obstruction with Surgically Altered Anatomy

“…Because the median patency time of plastic stents is 3 months or less, metal stents are generally placed in patients with unresectable disease who are expected to survive for longer than 3 months [9]. In patients with a gastrointestinal reconstruction, uncovered self-expandable metal stent (SEMSs) have been placed with the use of a commercially available balloon enteroscope or an anterior obliqueviewing endoscope [1,2,10]. However, the channel diameter of these endoscopes is only 2.8 mm.…”

Experience of the Endoscopists Matters in Endoscopic Retrograde Cholangiopancreatography in Billroth II Gastrectomy Patients

“…The therapeutic success rate in patients who had undergone Billroth II gastrectomy ranged from 76.2% to 91.7% with a side-viewing endoscope and from 62.5% to 91.3% with a forward-viewing endoscope (Table 5). 3,4,6,[9][10][11][12][13][14] In addition to the differences in endoscopic techniques, endoscopist experience, study design, use of endoscopic sphincterotomy and endoscopic papillary balloon dilatation, indications for ERCP, and differences in the number of patients included in the studies contributed to the wide range of success rates. In this study, the therapeutic success rate was 64%, which was quite low compared with that reported in the literature, but our technical success rate (81.3%) was consistent with that reported in previous studies.…”

Comparison of endoscopic sphincterotomy techniques after Billroth II gastrectomy using a novel mechanical simulator

“…These features render this oblique-viewing endoscopes as perfect tool for performing ERCP in patients with Billroth II reconstruction anatomy. Some Japanese studies have demonstrated a high success rate of ERCP in patients with prior BII reconstruction by using an oblique viewing endoscope (Kikuyama, Sasada, Matsuhashi, Ota, & Nakahodo, 2009;Nakahara, Okuse, Suetani, Morita, Michikawa, Ozawa, Hosoya, Nomoto, Kobayashi, Otsubo, & Itoh, 2015).…”