Recent advances in endoscopic retrograde cholangiopancreatography in Billroth II gastrectomy patients: A systematic review

Park, Tae Young; Song, Tae Jun

doi:10.3748/wjg.v25.i24.3091

Cited by 21 publications

(19 citation statements)

References 58 publications

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“…Finally, we consecutively performed BE-ERCP for patients with Billroth-II reconstruction. However, the effectiveness and safety of side-or forward-viewing endoscope was also reported for ERCP in this population [41]. Considering that Billroth-II is the potential risk factor of obvious perforation during BE-ERCP, further comparative study should be conducted in this setting.…”

Section: Early Adverse Eventsmentioning

confidence: 87%

Feasibility of balloon endoscope-assisted endoscopic retrograde cholangiopancreatography for the elderly

et al. 2020

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Background and study aims Endoscopic retrograde cholangiopancreatography (ERCP) for patients with surgically altered anatomy is challenging. Recently, balloon endoscopy has been shown to facilitate ERCP for this population with a high technical success rate, but adverse events (AEs) are not uncommon. Compared to non-elderly patients, elderly patients may be at higher risk of AEs due to underlying comorbidities. The current study aimed to evaluate the feasibility of balloon endoscope-assisted ERCP (BE-ERCP) for the elderly. Patients and methods We retrospectively identified patients who underwent BE-ERCP between January 2010 and September 2019. For patients who underwent multiple procedures during the study period, the first session was analyzed. Early AEs associated with BE-ERCP were compared between elderly (≥ 75 years) and non-elderly patients. Results A total of 1,363 BE-ERCP procedures were performed, and 568 patients (211 elderly and 357 non-elderly) were included for the analyses. Technical success rates were high in both the elderly and non-elderly groups (80 % vs. 80 %, respectively). The rates of early AEs were similar between the groups (12 % vs. 9.0 % in the elderly and non-elderly group, respectively; P = 0.31). The mltivariable-adjusted odds ratio for early AEs comparing elderly to non-elderly patients was 1.36 (95 % confidence interval, 0.74–2.51; P = 0.32). Specifically, we did not observe between-group differences in rates of gastrointestinal perforation (2.4 % vs. 2.8 % in elderly and non-elderly groups, respectively; P = 0.99) and aspiration pneumonia (1.9 % vs. 0.6 %, P = 0.20). Conclusions BE-ERCP is a feasible procedure for elderly individuals with surgically altered anatomy.

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Section: Early Adverse Eventsmentioning

confidence: 87%

Feasibility of balloon endoscope-assisted endoscopic retrograde cholangiopancreatography for the elderly

et al. 2020

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“…The prerequisites of an ideal endoscope are to guarantee safe endoscopic access through the angulated afferent limb and to embody the en face view of the papilla for selective cannulation and therapeutic interventions. Although many experienced endoscopists advocate the routine use of a side-viewing duodenoscope for ERCP in patients with Billroth II anatomy [ 2 , 7 ], previous studies have reported that the incidence of bowel perforation is higher with a side-viewing duodenoscope than with a forward-viewing endoscope [ 5 , 12 ]. Moreover, in a recent meta-analysis, procedure-related mortality occurred exclusively in the side-viewing duodenoscopy group [ 12 ].…”

Section: Discussionmentioning

confidence: 99%

“…Although many experienced endoscopists advocate the routine use of a side-viewing duodenoscope for ERCP in patients with Billroth II anatomy [ 2 , 7 ], previous studies have reported that the incidence of bowel perforation is higher with a side-viewing duodenoscope than with a forward-viewing endoscope [ 5 , 12 ]. Moreover, in a recent meta-analysis, procedure-related mortality occurred exclusively in the side-viewing duodenoscopy group [ 12 ]. To guide safe afferent limb navigation, anticipative insertion of a guidewire and catheter into the duodenal stump before duodenoscope advancement was attempted and showed a therapeutic success rate of 81.3–86.3%, a perforation rate of 0.0–1.8%, and procedure-related mortality of 0.0–0.3% in Billroth II gastrectomy patients [ 2 , 7 , 8 ].…”

Section: Discussionmentioning

confidence: 99%

Outcomes and Loop Pattern Analysis of a Road-Map Technique for ERCP with Side-Viewing Duodenoscope in Patients with Billroth II Gastrectomy (with Video)

Yang

Kim

Hwang

et al. 2021

JPM

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Endoscopic retrograde cholangiopancreatography (ERCP) in patients who have undergone a Billroth II gastrectomy is a major challenge. This study aimed to evaluate the outcomes of the road-map technique for duodenal intubation using a side-viewing duodenoscope for ERCP in Billroth II gastrectomy patients with naïve papilla, and to analyze the formation and release patterns of common bowel loops that occur when the duodenoscope navigates the afferent limb. The duodenoscopy approach success rate was 85.8% (97/113). In successful duodenoscopy approach patients, there were five bowel looping patterns that occurred when the preceding catheter-connected duodenoscope was advanced into the duodenum: (1) reverse ɣ-loop (29.9%), (2) fixed reverse ɣ-loop (5.2%), (3) simple U-loop (22.7%), (4) N-loop (28.9%), and (5) reverse alpha loop (13.4%). The duodenoscopy cannulation and duodenoscopy therapeutic success rates were 81.4% (92/113) and 80.5% (91/113), respectively, while the overall cannulation and therapeutic success rates were 92.0% (104/113) and 87.6% (99/113), respectively. Bowel perforation occurred in three patients (2.7%). The road-map technique may benefit duodenoscope-based ERCP in Billroth II gastrectomy patients by minimizing the tangential axis alignment between the duodenoscopic tip and driving of the afferent limb, and by predicting and counteracting bowel loops that occur when the duodenoscope navigates the afferent limb.

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“…In our present study, ERCP-related adverse events occurred in 25.6% of patients. Previous studies reported the complication rate from 3.5 to 12.4% [ 9 , 11 , 12 , 16 , 18 , 38 – 40 ]. However, hyperamylasemia was not included in most of these studies.…”

Section: Discussionmentioning

confidence: 99%

Risk factors for adverse events associated with endoscopic retrograde cholangiopancreatography in patients with surgically altered anatomy: a retrospective study

et al. 2021

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Introduction Endoscopic retrograde cholangiopancreatography (ERCP) is considered to be a challenge in patients with surgically altered anatomy. We aimed to identify the risk factors of ERCP-related adverse events in patients with surgically altered anatomy in our center. Methods We included patients with surgically altered anatomy who underwent ERCP between April 2017 and December 2020 at our center. Clinical characteristics and outcomes were analyzed in univariate and multivariate methods to identify the risk factors for adverse events. Results A total of 121 ERCP procedures were performed in 93 patients. The papilla or surgical anastomosis was successfully reached in 113 cases (93.4%). Diagnostic success was achieved in 106 cases (93.8%) and subsequent therapeutic success was achieved in 102 cases (96.2%). ERCP-related adverse events occurred in 31 cases (25.6%). In univariate analysis, not first time ERCP attempt, a CBD stone diameter ≥ 15 mm, multiple cannulation attempts, endoscopic papillary balloon dilation, endoscopic papillary large balloon dilation, endoscopic retrograde biliary drainage, biopsy in the bile duct or papilla, mechanical lithotripsy use, and stone retrieval basket were associated with ERCP-related adverse events. In multivariate analysis, multiple cannulation attempts (OR 5.283; 95% CI 1.088–25.659; p = 0.039), endoscopic papillary balloon dilation (OR 4.381; 95% CI 1.191–16.114; p = 0.026), and biopsy in the bile duct or papilla (OR 35.432; 95% CI 2.693–466.104; p = 0.007) were independently associated with ERCP-related adverse events. Conclusions ERCP in patients with surgically altered anatomy was feasible and safe. Interventions including multiple cannulation attempts, endoscopic papillary balloon dilation, and biopsy in the bile duct or papilla were independent risk factors for ERCP-related adverse events.

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Recent advances in endoscopic retrograde cholangiopancreatography in Billroth II gastrectomy patients: A systematic review

Cited by 21 publications

References 58 publications

Feasibility of balloon endoscope-assisted endoscopic retrograde cholangiopancreatography for the elderly

Feasibility of balloon endoscope-assisted endoscopic retrograde cholangiopancreatography for the elderly

Outcomes and Loop Pattern Analysis of a Road-Map Technique for ERCP with Side-Viewing Duodenoscope in Patients with Billroth II Gastrectomy (with Video)

Risk factors for adverse events associated with endoscopic retrograde cholangiopancreatography in patients with surgically altered anatomy: a retrospective study

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