Short-type single-balloon enteroscope-assisted ERCP in postsurgical altered anatomy: potential factors affecting procedural failure

Abstract

Short-type single-balloon enteroscope (short SBE)-assisted endoscopic retrograde cholangiopancreatography (ERCP) is a promising alternative treatment in postsurgical altered anatomy. However, it is technically demanding, and factors affecting its technical difficulty have not yet been clarified. This study aimed to examine the procedural success rate of short SBE-assisted ERCP and the potential factors affecting procedural failure. A total of 117 consecutive patients (203 procedures) with surgically altered anatomy underwent ERCP using prototype short SBEs. The procedural success rate of short SBE-assisted ERCP and the potential factors affecting procedural failure were examined retrospectively. The enteroscopy success rate and procedural success rate were 92.6 % (95 % confidence interval [CI] 88.1 % - 95.8 %) and 81.8 % (95 %CI 75.8 % - 86.8 %), respectively. Multivariate analyses indicated that pancreatic indication (odds ratio [OR] 4.35, 95 %CI 1.67 - 11.4), first ERCP attempt (OR 6.03, 95 %CI 2.17 - 16.8), and no transparent hood (OR 4.61, 95 %CI 1.48 - 14.3) were potential risk factors for procedural failure. Short SBE-assisted ERCP was effective in postsurgical altered anatomy. This large case series suggested the potential factors affecting procedural failure.

Analysis of the factors involved in procedural failure: Endoscopic retrograde cholangiopancreatography using a short‐type single‐balloon enteroscope for patients with surgically altered gastrointestinal anatomy

“…In the present study, procedural success rate for patients with surgically altered gastrointestinal anatomy was 85.9%, with an adverse rate of 8.4%. Our rates are comparable to those previously reported, with a procedural success rate of short SBE procedures in patients with altered gastrointestinal anatomy of 70–84.6%, and an adverse event rate of 3.8–11.8%. Overall, there is still room for improving the success rate of ERCP‐related procedures carried out using a short SBE in comparison to ERCP in patients with normal gastrointestinal anatomy.…”

“…However, in the present study, we did not identify a difference in success rate among all reconstruction methods. This finding is similar to those of previous studies that did not find a difference in the procedural success rate between the passive bending and conventional short SBE …”

Interventional endoscopic ultrasonography in patients with surgically altered anatomy: Techniques and literature review

“…Subsequently, the advent of balloon enteroscopes led to the carrying out of ERCP using these enteroscopes in patients with SAA. Since then, favorable outcomes have been achieved . However, even with enteroscopes, it is not always possible to reach the papilla, bile duct, or pancreatic anastomotic site in all patients.…”

Endoscopic ultrasound‐guided fistulation between bile duct and afferent limb for treatment of complete choledochojejunal obstruction using forward‐viewing echoendoscope

“…An obstruction at the choledochojejunal anostomosis after biliary surgery is usually treated by balloon enteroscope‐assisted endoscopic retrograde cholangiopancreatography (BE‐ERCP) . However, biliary intervention is difficult in patients with complete obstruction.…”