Review of diagnostic and therapeutic endoscopic retrograde cholangiopancreatography using several endoscopic methods in patients with surgically altered gastrointestinal anatomy

Abstract

The endoscopic approach for biliary diseases in patients with surgically altered gastrointestinal anatomy (SAGA) had been generally deemed impractical. However, it was radically made feasible by the introduction of double balloon endoscopy (DBE) that was originally developed for diagnosis and treatments for small-bowel diseases. Followed by the subsequent development of single-balloon endoscopy (SBE) and spiral endoscopy (SE), interventions using several endoscopes for biliary disease in patients with SAGA widely gained an acceptance as a new modality. Many studies have been made on this new technique. Yet, some problems are to be solved. For instance, the mutual unavailability among devices due to different working lengths and channels, and unestablished standardization of procedural techniques can be raised. Additionally, in an attempt to standardize endoscopic procedures, it is important to evaluate biliary cannulating methods by case with existence of papilla or not. A full comprehension of the features of respective scope types is also required. However there are not many papers written as a review. In our manuscript, we would like to evaluate and make a review of the present status of diagnostic and therapeutic endoscopic retrograde cholangiopancreatography applying DBE, SBE and SE for biliary diseases in patients with SAGA for establishment of these modalities as a new technology and further improvement of the scopes and devices.

Keywords: Double balloon endoscopy; Endoscopic retrograde cholangiopancreatography; Roux-en-Y reconstruction; Single balloon endoscopy; Spiral endoscopy.

Figure 1

Schema of types of surgical anatomic reconstruction from gastrectomy. A: Billroth II reconstruction; B: Roux-en-Y reconstruction; C: Double-tract reconstruction; D: Jejunal pouch interposition.

Figure 2

Schema of types of surgical anatomic reconstruction from pancreaticoduodenectomy. A: The Whipple Method; B: The (modified) Child surgery; C: The Cattell Method; D: The Imanaga Method.

Figure 3

Double-balloon endoscopy. The short type double balloon enteroscope (EC- 530B; FUJIFILM, Osaka, Japan) with a working channel of 2.8 mm diameter and a working length of 152 cm.

Figure 4

Single-balloon endoscopy. The standard type double balloon enteroscope (SIF- Q260; Olympus Systems, Tokyo, Japan) with a working channel of 2.8 mm diameter and a working length of 200 cm.

Figure 5

Spiral endoscopy. Discovery SB overtube over the snteroscope.

Figure 6

Schema of double-balloon endoscopy insertion.

Figure 7

Schema of single-balloon endoscopy insertion.

Figure 8

Biliary cannulation using double-balloon endoscopy in a patient with papilla. A: Papilla when the blind end was accessed; B: Locating papilla in 6 o’clock direction in the monitor, and performing cannulation adjusting the axis of catheter into 12 o’clock direction along the biliary duct.

Figure 9

Biliary cannulation using single-balloon endoscopy in a patient with papilla. A: Papilla when the blind end was accessed; B: Locating papilla in 8-9 o’clock direction in the monitor, and performing cannulation adjusting the axis of catheter into 3 o’clock direction along the biliary duct.