Potential Factors Affecting Results of Short-Type Double-Balloon Endoscope-Assisted Endoscopic Retrograde Cholangiopancreatography

Uchida, Daisuke; Tsutsumi, Keisuke; Kato, Hironari; Matsumi, Akihiro; Saragai, Yosuke; Tomoda, Takeshi; Matsumoto, Kazuyuki; Horiguchi, Shigeru; Okada, Hiroyuki

doi:10.1007/s10620-019-05857-3

Cited by 21 publications

(19 citation statements)

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“…Since common bile duct (CBD) stones often cause patients life-threatening severe cholangitis and pancreatitis, biliary intervention, such as stone extraction or biliary drainage, is required [ 4 , 5 ]. However, endoscopic treatment of CBD stones via the papilla of Vater is technically challenging, especially in patients who have undergone R-Y gastrectomy (RYG), due to the difficulty of not only reaching the papilla but also performing biliary cannulation or ampullary procedures or stone extraction [ 6 , 7 , 8 , 9 , 10 ], compared to those with normal anatomy. Thus, percutaneous transhepatic intervention or surgery is often performed as an alternative treatment [ 11 , 12 , 13 , 14 ].…”

Section: Introductionmentioning

confidence: 99%

Balloon Enteroscopy-Assisted Endoscopic Retrograde Cholangiopancreatography for the Treatment of Common Bile Duct Stones in Patients with Roux-en-Y Gastrectomy: Outcomes and Factors Affecting Complete Stone Extraction

Obata

Tsutsumi

Kato

et al. 2021

JCM

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Background: Endoscopic retrograde cholangiopancreatography (ERCP) for extraction of common bile duct (CBD) stones in patients with Roux-en-Y gastrectomy (RYG) remains technically challenging. Methods: Seventy-nine RYG patients (median 79 years old) underwent short-type double-balloon enteroscopy-assisted ERCP (sDBE-ERCP) for CBD stones at three referral hospitals from 2011–2020. We retrospectively investigated the treatment outcomes and potential factors affecting complete stone extraction. Results: The initial success rates of reaching the papilla of Vater, biliary cannulation, and biliary intervention, including complete stone extraction or biliary stent placement, were 92%, 81%, and 78%, respectively. Of 57 patients with attempted stone extraction, complete stone extraction was successful in 74% for the first session and ultimately in 88%. The adverse events rate was 5%. The multivariate analysis indicated that the largest CBD diameter ≥14 mm (odds ratio (OR), 0.04; 95% confidence interval (CI), 0.01–0.58; p = 0.018) and retroflex position (OR, 6.43; 95% CI, 1.12–36.81; p = 0.037) were independent predictive factors affecting complete stone extraction achievement. Conclusions: Therapeutic sDBE-ERCP for CBD stones in a relatively elderly RYG cohort, was effective and safe. A larger CBD diameter negatively affected complete stone extraction, but using the retroflex position may be useful for achieving complete stone clearance.

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Section: Introductionmentioning

confidence: 99%

Balloon Enteroscopy-Assisted Endoscopic Retrograde Cholangiopancreatography for the Treatment of Common Bile Duct Stones in Patients with Roux-en-Y Gastrectomy: Outcomes and Factors Affecting Complete Stone Extraction

Obata

Tsutsumi

Kato

et al. 2021

JCM

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“…The current literature on EDGE is limited. Published studies have included 30 or fewer patients and long-term follow-up data are scant. Specifically, the rates of persistent gastrogastric fistula or jejunogastric fistula are unknown.…”

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confidence: 99%

Endoscopic ultrasound-directed transgastric ERCP (EDGE): a retrospective multicenter study

et al. 2020

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Background and Study Aims: Endoscopic ultrasound-directed transgastric ERCP (EDGE) is an alternative to enteroscopy- and laparoscopy-assisted ERCP in patients with Roux-en-Y gastric bypass anatomy. Although short-term results are promising, the long-term outcomes are not known. Aims of this study were 1) to determine rates of long-term adverse events (AEs) after EDGE, with a focus on rates of persistent gastrogastric or jejunogastric fistula; 2) identify predictors of persistent fistula; 3) assess outcomes of endoscopic closure when persistent fistula is encountered. Patients and Methods: This was a multicenter, retrospective study involving 13 centers between 1/2014 and 3/2019. AEs were defined according to ASGE lexicon. Persistent fistula was defined as upper GI series or EGD showing evidence of fistula. Results: A total of 178 patients (mean age 58 years, 79% F) underwent EDGE. Technical success was achieved in 98% of cases (175/178) with a mean procedure time of 92 min. Periprocedural AEs occurred in 28 patients (15.7%; mild 10.1%, moderate 3.3%, severe 2.2%). The 4 severe adverse events were managed laparoscopically. Persistent fistula was diagnosed in 10% of those sent for objective testing (9/90). Following identification of fistula, 5/9 patients underwent endoscopic closure procedures, which were successful in all cases. Conclusions: The EDGE procedure is associated with high clinical success rates, and an acceptable risk profile. Persistent fistula after lumen apposing stent removal are uncommon, but objective testing is recommended to identify their presence. When persistent fistula are identified, endoscopic treatment is warranted, and should be successful in closing the fistula.

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“…14 Table 3 shows the outcomes of short-type DBE-assisted ERCP in patients with SAA. 9,10,[12][13][14][15][16][17][18][19][20][21][22][23][24][25][26][27][28] The success rates of reaching the target site, biliary cannulation, and therapeutic procedure in short-type DBE-assisted ERCP were 94.8%, 95.6%, and 94.5%, respectively, from these pooled data. On the other hand, the latest systematic review and meta-analysis reported that the success rates of reaching the target site, biliary cannulation, and therapeutic procedure in both short-type and standardtype DBE-assisted ERCP were 90%, 94%, and 93%, respectively.…”

Section: Short-type Double Balloon-assisted Ercpmentioning

confidence: 87%

Recent advances of endoscopic retrograde cholangiopancreatography in surgically altered anatomy

Kim

Yang

2021

Int J Gastrointest Interv

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Endoscopic retrograde cholangiopancreatography (ERCP) in patients with surgically altered anatomy (SAA) of the upper gastrointestinal tract is a more technically challenging and arduous procedure accompanied by a low success rate of reaching the target orifice and a relatively high rate of complications, compared to those with normal anatomy. Since the introduction of device-assisted enteroscopies such as balloon enteroscopy (BE) and manual spiral enteroscopy (SE) for small bowel disorders, they have also been used for ERCP in patients with SAA. The recent development of short-type BE makes ERCP in patients with SAA technically easier with high success rates and short procedural duration, and then short-type BE is considered the gold standard endoscopic procedure in these patients. Laparoscopy-assisted ERCP is another therapeutic option, especially for patients with a long excluded afferent limb of SAA. The choice of procedure for high success rates should be individualized according to patient characteristics and available physician competence. Moreover, novel motorized SE is a promising alternative procedure for the successful performance of ERCP.

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Potential Factors Affecting Results of Short-Type Double-Balloon Endoscope-Assisted Endoscopic Retrograde Cholangiopancreatography

Cited by 21 publications

References 18 publications

Balloon Enteroscopy-Assisted Endoscopic Retrograde Cholangiopancreatography for the Treatment of Common Bile Duct Stones in Patients with Roux-en-Y Gastrectomy: Outcomes and Factors Affecting Complete Stone Extraction

Balloon Enteroscopy-Assisted Endoscopic Retrograde Cholangiopancreatography for the Treatment of Common Bile Duct Stones in Patients with Roux-en-Y Gastrectomy: Outcomes and Factors Affecting Complete Stone Extraction

Endoscopic ultrasound-directed transgastric ERCP (EDGE): a retrospective multicenter study

Recent advances of endoscopic retrograde cholangiopancreatography in surgically altered anatomy

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