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. 2020 Feb 10;7(2):131-139.
doi: 10.14744/nci.2020.54533. eCollection 2020.

Double balloon enteroscopy improves ERCP success in patients with modified small bowel anatomy

Goktug Sirin  1 , Sadettin Hulagu  1
Affiliations

Double balloon enteroscopy improves ERCP success in patients with modified small bowel anatomy

Goktug Sirin et al. North Clin Istanb. .

Abstract

Objective: The aim of this study was to evaluate the effect of double-balloon enteroscopy (DBE) on the success of endoscopic retrograde cholangiopancreatography (ERCP) procedures in patients with surgically modified gastrointestinal (GI) tract anatomy.

Methods: The medical records of patients who underwent ERCP in the Gastroenterology Department of Kocaeli University School of Medicine hospital between December 2008 and September 2014 were examined. From the patient group that was scheduled to undergo DBE-ERCP, the details of cases in which ERCP via standard duodenoscope or DBE-ERCP was performed during the same session because standard ERCP failed were included. Procedure parameters, outcomes, and complications related to the procedure in both groups were analyzed. Patients who underwent the DBE-ERCP procedure directly, those who underwent push enteroscopy, or gastroscopy to evaluate the GI tract anatomy before the day of ERCP, and who underwent DBE-ERCP on a day other than the initial ERCP session were excluded. Afferent loop intubation, access to the major papilla, selective cannulation, therapeutic success rates, and the effect of DBE on overall procedure success were evaluated.

Results: Fifty-one patients with a history of BII gastrojejunostomy and 11 patients with hepaticojejunostomy (with or without Roux-en-Y) were included in the study. In all patients, the ERCP procedure was initiated with a standard duodenoscope. If intubation of the afferent loop was unsuccessful in reaching the major papilla or enterobiliary anastomosis, DBE was used. In 30 (48.4%) of the 62 patients whose GI tract was anatomically altered, the duodenoscope was successfully advanced to the ampulla and 27 (43.5%) were cannulated successfully. Thirty-one patients underwent DBE-ERCP. DBE reached the ampulla or enterobiliary anastomosis in 30 patients (96.8%) and selective choledocus cannulation was achieved in all patients but 3 (90%), including 1 patient with a hepaticojejunostomy. The overall ERCP success rate increased from 43.5% (27/62) to 87.1% (54/62). Two perforations (1 during standard duodenoscopy and 1 with DBE-ERCP) were observed.

Conclusion: The overall success rate of ERCP increased with use of the DBE technique in patients with small bowel anatomic variations that were the result of previous surgery.

Keywords: Billroth II gastric resection; Roux-en-Y reconstruction; double-balloon enteroscopy; endoscopic retrograde cholangiopancreatography; hepaticojejunostomy.

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Conflict of interest statement

Conflict of Interest: No conflict of interest was declared by the authors.

Figures

FIGURE 1
FIGURE 1
Normal cholangiogram image in a patient with billroth II gastric resection (using standard side-view duodenoscope).
FIGURE 2
FIGURE 2
Biliary stone on cholangiogram in a patient with billroth II gastric resection and stone balloon application (using standard side-view duodenoscope).
FIGURE 3
FIGURE 3
During DBE-ERCP procedure, DBE is advanced in the surgically modified small intestine (fluoroscopic view). DBE: Double balloon enteroscopy; ERCP: Endoscopic retrograde cholangiopancreatography; DBE-ERCP: ERCP with DBE.
FIGURE 4
FIGURE 4
Cholangiography image in a patient with Hepaticojejunostomy who underwent liver resection for cholangiocarcinoma (procedure was performed with DBE, using accessories longer than standard ones).
FIGURE 5
FIGURE 5
Endoscopic view of narrowed hepaticojejunostomy anastomosis opening (image was taken with DBE).
FIGURE 6
FIGURE 6
Enlargement in Hepaticojejunostomy anastomosis stricture after balloon dilatation (endoscopic view) (procedure was performed with DBE).
See this image and copyright information in PMC

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