Single-Balloon Enteroscopy–Assisted ERCP in Patients With Billroth II Gastrectomy or Roux-en-Y Anastomosis (With Video)

Abstract

SBE-assisted ERCP using an overtube-assisted technique appears to be promising for performing therapeutic ERCP in patients with B-II or R-Y.

Approach of the Bile Duct by Gastrostomy in Patients With Bypass in Roux-en-Y Proved to Be Safe and Effective

“…The success rates obtained in the present study are similar to those described for the conventional method, for per-oral route; being superior to those obtained with the use of frontal vision devices [18,[19][20][21][22][23][24][25][26][27][28][29][30][31].…”

“…The high success rates of both papillary reach and bile duct catheterization should be attributed to the fact that most of the patients reported were not carriers of Roux-en-Y made with the purpose of weight loss, thus presenting segments of intestinal loops that make up the Y shorter, when compared to patients after bariatric surgery. Another determining factor in obtaining high success rates of papilla catheterization was the presence of digestive bile anastomoses instead of the native papilla in most patients [18][19][20][21][22][23][24][25][26][27][28][29][30][31]. Increased complication rates in these procedures, including perforation and pancreatitis, have also been reported [15,20,26,30,32,33].…”

“…In this context, success rates of papillary or bile anastomosis range 55.0-100.0% in the series described in the literature, with catheterization rates, after reaching, above 90.0% [18][19][20][21][22][23][24][25][26][27][28][29][30][31], no identified significant difference between methods [28]. The high success rates of both papillary reach and bile duct catheterization should be attributed to the fact that most of the patients reported were not carriers of Roux-en-Y made with the purpose of weight loss, thus presenting segments of intestinal loops that make up the Y shorter, when compared to patients after bariatric surgery.…”

Management of acute cholecystitis and acute cholangitis in emergency setting

“…Recent innovation has added single-or doubleballoon enteroscopy-assisted biliary drainage and endoscopic ultrasonography-guided biliary drainage to the endoscopic biliary drainage armamentarium [58,59]. In patients with altered surgical anatomy such as previous Roux-en-Y anastomosis, enteroscopy assisted biliary drainage can be useful [60].…”

Modified single-balloon endoscopy for ERCP in a patient with Billroth II gastrectomy

“…The sliding tube has a working length of 132 cm, with outer and inner diameters of 13.2 mm and 11 mm respectively, and has a silicone balloon at its tip [1]. An adequate aperture was made in the overtube at a point 75 cm from its tip on the side opposite to the pressure line.…”