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

Çağlar, Erkan; Atasoy, Deniz; Tozlu, Mukaddes; Altınkaya, Engin; Doğan, Serkan; Şentürk, Hakan

doi:10.5946/ce.2019.073

Cited by 13 publications

(9 citation statements)

References 24 publications

(40 reference statements)

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“…In another study which evaluated the experience of endoscopists in ERCP procedure in 75 Billroth II gastrectomy patients, ERCP success rate of an inexperienced endoscopist was found to be lower, but was not statistically significant. In the same study, perforation rate of the afferent loop for inexperienced endoscopist was higher than the experienced endoscopist (6.25% vs 0%) [10]. In our study, ERCP procedures were performed by a single experienced endoscopist in a single high-volume center.…”

Section: Discussionmentioning

confidence: 52%

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A comparative study of side-viewing duodenoscope and forward-viewing gastroscope to perform endoscopic retrograde cholangiopancreatography in patients with Billroth II gastrectomy

Çoşkun

Ödemiş

2020

Surg Endosc

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Background/aim Endoscopic retrograde cholangiopancreatography (ERCP) in patients with Billroth II gastrectomy is a difficult procedure. Although different endoscopes are used in these patients, comparative studies are limited. The aim of this study was to assess the efficacy and the safety of the forward-viewing gastroscope compared with the side-viewing duodenoscope.Materials and methods This study was conducted on 75 Billroth II gastrectomy patients who underwent ERCP by the same experienced endoscopist. Procedures were performed using side-viewing duodenoscope in the first 41 patients and forwardviewing gastroscope in the subsequent 34 patients. The success and complication rates of ERCP were compared between the two groups. Results Afferent loop intubation was achieved in 39 patients (95.1%) in the side-viewing duodenoscope group and in 34 patients (100%) in the forward-viewing gastroscope group (P = 0.49). The rates of reaching the papilla was 70.7% (n = 29) and 91.1% (n = 31), respectively (P = 0.06). Cannulation success rate after reaching the papilla was 100% in the side-viewing duodenoscope group and 90.3% in the forward-viewing gastroscope group. In the side-viewing duodenoscope group, 11 patients underwent sphincterotomy (EST), 14 patients underwent both EST and endoscopic papillary balloon dilatation (EPBD), and 4 patients underwent only EPBD. All but one patients in the forward-viewing gastroscope group underwent EPBD without EST. The technical and the clinical success rate did not statistically differ between the groups (70.7% vs. 82.3%, 68.3% vs. 79.4%, respectively). Adverse events included jejunal perforation in one patient (2.4%) in the side-viewing duodenoscope group, and pancreatitis in one patient (2.9%) in the forward-viewing gastroscope group (P > 0.05). Conclusion This study indicates that forward-viewing gastroscope is as effective as side-viewing duodenoscope for ERCP in patients with Billroth II gastrectomy. Furthermore, EPBD without prior EST appears to be a safe and effective procedure in these patients. Keywords Endoscopic retrograde cholangiopancreatography • Billroth II operation • Endoscope • DuodenoscopeEndoscopic retrograde cholangiopancreatography (ERCP) is considered the first step treatment of many biliary and pancreatic diseases [1]. Experienced endoscopists can successfully perform many ERCP procedures in patients with normal anatomy. However, in patients with Billroth II gastrectomy, ERCP is a difficult procedure because of surgically altered anatomy. Entering the afferent loop, advancing towards the papilla, visualizing the papilla, cannulating the desired duct, and performing endoscopic sphincterotomy (EST) are the main problems [1,2]. While the risk of perforation during ERCP is 0.1-0.6% in patients with normal anatomy, this rate can rise to 10% in patients with Billroth II gastrectomy [1,3,4]. The incidence of other ERCP-related complications in patients with Billroth II gastrectomy is similar to that of patients with normal anatomy [5].Although different endoscopes su...

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Section: Discussionmentioning

confidence: 52%

“…Clinical success rate of ERCP in patients with Billroth II gastrectomy have ranged from 62.5-91.7% with the sideviewing duodenoscope compared to 62.5-91.3% with the forward-viewing endoscope [1,2,4,10,11]. In our study, the desired clinical goal was achieved in 68.3% and 79.4% of patients, respectively.…”

Section: Discussionmentioning

confidence: 55%

A comparative study of side-viewing duodenoscope and forward-viewing gastroscope to perform endoscopic retrograde cholangiopancreatography in patients with Billroth II gastrectomy

Çoşkun

Ödemiş

2020

Surg Endosc

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“…The relative difficulty of ERCP procedures may vary depending on patient characteristics, biliary anatomy, procedural indication, and intervention. 7 , 13 According to one grading system, ERCP procedures for small-to-medium sized biliary stones are less difficult to identify than extrahepatic strictures. 7 , 14 This is congruent with the findings of the present study.…”

Section: Discussionmentioning

confidence: 99%

Increased ERCP volume improves cholangiogram interpretation: a new performance measure for ERCP training?

et al. 2022

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Background/Aims: Cholangiogram interpretation is not used as a key performance indicator (KPI) of endoscopic retrograde cholangiopancreatography (ERCP) training, and national societies recommend different minimum numbers per annum to maintain competence. This study aimed to determine the relationship between correct ERCP cholangiogram interpretation and experience. Methods: One hundred fifty ERCPists were surveyed to appropriately interpret ERCP cholangiographic findings. There were three groups of 50 participants each: "Trainees, " "Consultants Group 1" (performed >75 ERCPs per year), and "Consultants Group 2" (performed >100 ERCPs per year). Results: Trainees was inferior to Consultants Groups 1 and 2 in identifying all findings except choledocholithiasis outside the intrahepatic duct on the initial or completion/occlusion cholangiogram. Consultants Group 1 was inferior to Consultants Group 2 in identifying Strasberg type A bile leaks (odd ratio [OR] 0.86, 95% confidence interval [CI] 0.77-0.96), Strasberg type B (OR 0.84, 95% CI 0.74-0.95), and Bismuth type 2 hilar strictures (OR 0.81, 95% CI 0.69-0.95). Conclusions: This investigation supports the notion that cholangiogram interpretation improves with increased annual ERCP case volumes. Thus, a higher annual volume of procedures performed may improve the ability to correctly interpret particularly difficult findings. Cholangiogram interpretation, in addition to bile duct cannulation, could be considered as another KPI of ERCP training.

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“…The postprocedural follow-up period was 7 d in both the groups. Choi et al [ 32 ] reported a higher technical success rate in the PTBD group than in the EUS-BD group, although the functional success rate was comparable between the two groups[ 35 ].…”

Section: Discussionmentioning

confidence: 99%

Percutaneous transhepatic cholangiography vs endoscopic ultrasound-guided biliary drainage: A systematic review

Hassan¹,

Gadour²

2022

WJG

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BACKGROUND Percutaneous transhepatic cholangiography is a diagnostic and therapeutic procedure that involves inserting a needle into the biliary tree, followed by the immediate insertion of a catheter. Endoscopic ultrasound-guided biliary drainage (EUS-BD) is a novel technique that allows BD by echoendoscopy and fluoroscopy using a stent from the biliary tree to the gastrointestinal tract. AIM To compare the technical aspects and outcomes of percutaneous transhepatic BD (PTBD) and EUS-BD. METHODS Different databases, including PubMed, Embase, clinicaltrials.gov, the Cochrane library, Scopus, and Google Scholar, were searched according to the guidelines for Preferred Reporting Items for Systematic reviews and Meta-Analyses to obtain studies comparing PTBD and EUS-BD. RESULTS Among the six studies that fulfilled the inclusion criteria, PTBD patients underwent significantly more reinterventions (4.9 vs 1.3), experienced more postprocedural pain (4.1 vs 1.9), and experienced more late adverse events (53.8% vs 6.6%) than EUS-BD patients. There was a significant reduction in the total bilirubin levels in both the groups (16.4-3.3 μmol/L and 17.2-3.8 μmol/L for EUS-BD and PTBD, respectively; P = 0.002) at the 7-d follow-up. There were no significant differences observed in the complication rates between PTBD and EUS-BD (3.3 vs 3.8). PTBD was associated with a higher adverse event rate than EUS-BD in all the procedures, including reinterventions (80.4% vs 15.7%, respectively) and a higher index procedure (39.2% vs 18.2%, respectively). CONCLUSION The findings of this systematic review revealed that EUS-BD is linked with a higher rate of effective BD and a more manageable procedure-related adverse event profile than PTBD. These findings highlight the evidence for successful EUS-BD implementation.

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

Cited by 13 publications

References 24 publications

A comparative study of side-viewing duodenoscope and forward-viewing gastroscope to perform endoscopic retrograde cholangiopancreatography in patients with Billroth II gastrectomy

A comparative study of side-viewing duodenoscope and forward-viewing gastroscope to perform endoscopic retrograde cholangiopancreatography in patients with Billroth II gastrectomy

Increased ERCP volume improves cholangiogram interpretation: a new performance measure for ERCP training?

Percutaneous transhepatic cholangiography vs endoscopic ultrasound-guided biliary drainage: A systematic review

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