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. 2021 Jul 27;10(15):3314.
doi: 10.3390/jcm10153314.

Balloon Enteroscopy-Assisted Endoscopic Retrograde Cholangiopancreatography for the Treatment of Common Bile Duct Stones in Patients with Roux-en-Y Gastrectomy: Outcomes and Factors Affecting Complete Stone Extraction

Taisuke Obata  1 , Koichiro Tsutsumi  1 , Hironari Kato  1 , Toru Ueki  2 , Kazuya Miyamoto  3 , Tatsuhiro Yamazaki  1 , Akihiro Matsumi  1 , Yuki Fujii  1 , Kazuyuki Matsumoto  1 , Shigeru Horiguchi  1 , Kengo Yasugi  2 , Tsuneyoshi Ogawa  2 , Ryuta Takenaka  3 , Hiroyuki Okada  1
Affiliations

Balloon Enteroscopy-Assisted Endoscopic Retrograde Cholangiopancreatography for the Treatment of Common Bile Duct Stones in Patients with Roux-en-Y Gastrectomy: Outcomes and Factors Affecting Complete Stone Extraction

Taisuke Obata et al. J Clin Med. .

Abstract

Background: Endoscopic retrograde cholangiopancreatography (ERCP) for extraction of common bile duct (CBD) stones in patients with Roux-en-Y gastrectomy (RYG) remains technically challenging.

Methods: Seventy-nine RYG patients (median 79 years old) underwent short-type double-balloon enteroscopy-assisted ERCP (sDBE-ERCP) for CBD stones at three referral hospitals from 2011-2020. We retrospectively investigated the treatment outcomes and potential factors affecting complete stone extraction.

Results: The initial success rates of reaching the papilla of Vater, biliary cannulation, and biliary intervention, including complete stone extraction or biliary stent placement, were 92%, 81%, and 78%, respectively. Of 57 patients with attempted stone extraction, complete stone extraction was successful in 74% for the first session and ultimately in 88%. The adverse events rate was 5%. The multivariate analysis indicated that the largest CBD diameter ≥ 14 mm (odds ratio (OR), 0.04; 95% confidence interval (CI), 0.01-0.58; p = 0.018) and retroflex position (OR, 6.43; 95% CI, 1.12-36.81; p = 0.037) were independent predictive factors affecting complete stone extraction achievement.

Conclusions: Therapeutic sDBE-ERCP for CBD stones in a relatively elderly RYG cohort, was effective and safe. A larger CBD diameter negatively affected complete stone extraction, but using the retroflex position may be useful for achieving complete stone clearance.

Keywords: Roux-en-Y anastomosis; bile duct stone; complete stone removal; endoscopic retrograde cholangiography; gastrectomy; short-type balloon enteroscopy.

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Conflict of interest statement

The authors declare no conflict of interest.

Figures

Figure 1
Figure 1
A useful “retroflex position” for stone extraction in a Roux-en-Y gastrectomy patient. (A) At the initial session, the scope was stretched after reaching the papilla (not formed the retroflex position). Following successful biliary cannulation, precutting, and endoscopic papillary large balloon dilation, a stone was able to be grabbed with a mechanical lithotripter. However, complete stone extraction was not able to be conducted using any devices, including a basket catheter or balloon catheter, as the axis of the devices did not align with the distal bile duct during the extraction. (B) In the second session, the retroflex position was obtained by forming a looped-scope shape. In this manner, the coaxial relationship between the devices and the distal bile duct and a proper distance from the tip of the scope to the papilla of Vater with a better view of the papilla could thus be successfully obtained. This situation allowed stones to be easily removed along the axis of the distal bile duct.
Figure 1
Figure 1
A useful “retroflex position” for stone extraction in a Roux-en-Y gastrectomy patient. (A) At the initial session, the scope was stretched after reaching the papilla (not formed the retroflex position). Following successful biliary cannulation, precutting, and endoscopic papillary large balloon dilation, a stone was able to be grabbed with a mechanical lithotripter. However, complete stone extraction was not able to be conducted using any devices, including a basket catheter or balloon catheter, as the axis of the devices did not align with the distal bile duct during the extraction. (B) In the second session, the retroflex position was obtained by forming a looped-scope shape. In this manner, the coaxial relationship between the devices and the distal bile duct and a proper distance from the tip of the scope to the papilla of Vater with a better view of the papilla could thus be successfully obtained. This situation allowed stones to be easily removed along the axis of the distal bile duct.
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