Long‐term outcomes after therapeutic endoscopic retrograde cholangiopancreatography using balloon‐assisted enteroscopy for anastomotic stenosis of choledochojejunostomy/pancreaticojejunostomy

Abstract

Background and Aim Data on long‐term outcomes after therapeutic endoscopic retrograde cholangiopancreatography (ERCP) using balloon‐assisted enteroscopy (BAE) for choledochojejunal anastomotic stenosis (CJS) or pancreaticojejunal anastomotic stenosis (PJS) remain limited. We retrospectively assessed the long‐term results of patients who achieved clinical success using BAE for CJS and PJS. Methods Patients who achieved technical and clinical success for CJS or PJS by BAE‐ERCP and were followed up for more than 6 months after the initial BAE‐ERCP therapy were retrospectively identified at 11 Japanese institutions. The primary end‐point was CJS or PJS recurrence rates. The secondary end‐points were initial therapy details, initial therapy complications, and CJS or PJS recurrence treatment details. We also evaluated restenosis‐associated factors. Results From September 2008 to December 2015, 67 patients (CJS, 61; PJS, six) were included. The overall CJS and PJS recurrence rates were 34.4% and 33.3%, respectively. The 1‐year CJS recurrence rate was 18.5% (95% confidence interval, 10.7–31.0). Of all the patients, 88.1% underwent balloon dilation at the anastomotic stenosis site; stent placement was performed in 15 of 67 patients (22.4%). The complication rate was 8.2% in CJS and 0% in PJS. In patients who underwent balloon dilation, “remaining waist” was significantly associated with CJS recurrence after anastomotic balloon dilation (P = 0.001). Conclusions The long‐term outcomes of BAE‐ERCP were comparable with those of percutaneous transhepatic treatment or surgical re‐anastomosis.

Endoscopic retrograde cholangiopancreatography with balloon-assisted enteroscopy in patients with Roux-en-Y anastomosis and Whipple operation

“…With the popularization and development of BAE technology, ERCP in patients with a surgically altered anatomy is gradually increasing. [ 12 , 13 ] However, the use of these new endoscopes may lead to new difficulties and complications, such as previously unseen types of barotrauma in closed afferent intestinal limbs. There are currently no gold standard approaches for addressing biliopancreatic disorders in patients with a surgically altered anatomy.…”

When the balloon goes up …

“…In this issue of JGH, Behary et al identified and validated six optical features used to differentiate benign from neoplastic biliary lesions assessed at balloon-assisted cholangioscopy (BAC), 1 while Sano et al reported that therapeutic endoscopic retrograde cholangiopancreatography (ERCP) using balloon-assisted enteroscopy (BAE) for anastomotic stenosis of choledocho-/ pancreaticojejunostomy could achieve long-term success rates comparable to percutaneous transhepatic treatment or surgical reanastomosis. 2 ERCP in patients with surgically altered anatomy has lower success and higher complication rates compared to ERCP in patients with normal anatomy. 3 Nonetheless, an endoscopic approach is considered less invasive and preferred over percutaneous transhepatic treatment and surgery.…”

“…identified and validated six optical features used to differentiate benign from neoplastic biliary lesions assessed at balloon‐assisted cholangioscopy (BAC), while Sano et al . reported that therapeutic endoscopic retrograde cholangiopancreatography (ERCP) using balloon‐assisted enteroscopy (BAE) for anastomotic stenosis of choledocho‐/pancreaticojejunostomy could achieve long‐term success rates comparable to percutaneous transhepatic treatment or surgical re‐anastomosis …”

Piercing technique via cholangioscopy for the reconstruction of complete anastomotic obstruction after choledochojejunostomy

“…2c,d) (Video S1). Although most CJs are treatable by BE‐ERCP or EUS‐guided procedure, 2–5 some cases require other approaches. To avoid invasive surgery, the piercing technique for cases of complete obstruction of CJs and the percutaneous route for taking the correct direction are useful.…”