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. 2021 Sep;22(9):545-550.
doi: 10.1111/1751-2980.13040. Epub 2021 Sep 2.

Endoscopic retrograde cholangiopancreatography using short-type double-balloon enteroscope: Experience in Hong Kong

Ka Shing Cheng  1 , Michael Kin Kong Li  1 , Wai Man Yip  2 , Wai Lok Choi  1 , Man Chung Fong  1
Affiliations

Endoscopic retrograde cholangiopancreatography using short-type double-balloon enteroscope: Experience in Hong Kong

Ka Shing Cheng et al. J Dig Dis. 2021 Sep.

Abstract

Objective: To illustrate the efficacy and safety profile of double-balloon enteroscopy (DBE)-assisted endoscopic retrograde cholangiopancreatography (ERCP) using a short enteroscope in patients with surgically altered anatomy.

Methods: A retrospective study was performed to review the endoscopic outcomes of patients undergoing DBE-assisted ERCP for biliary diseases in Tuen Mun and Pok Oi hospitals in Hong Kong SAR, China from December 2015 to December 2020.

Results: Altogether 46 DBE-assisted ERCP procedures were performed in 37 patients. The enteroscopic success rate, defined as reaching the papilla or bilioenteric anastomosis, was 95.7% (95% confidence interval [CI] 85.2%-99.5%), which was significantly lower in patients with intact stomach than in those who had a previous gastrectomy (67% vs 100%, P = 0.014). The diagnostic ERCP success rate, defined as performance in an informative cholangiogram, was 84.1% (95% CI 69.9%-93.4%) in cases where it was attempted. Intended biliary therapeutic interventions were successfully performed in 76.1% (95% CI 61.2%-87.4%) of all procedures. Adverse events were reported in six (13.0%) procedures (95% CI 4.9%-26.3%), including the micro-perforation of the intestine in two (4.3%) patients with prior Roux-en-Y gastrectomy, three (6.5%) of acute cholangitis and one (2.2%) of acute pancreatitis. All adverse events were managed successfully using conservative methods except in one case of micro-perforation, which required a laparotomy.

Conclusions: DBE-assisted ERCP using a short enteroscope is a promising technique for managing biliary diseases in patients with surgically altered anatomy. It must be performed to avoid perforation, particularly in patients with a Roux-en-Y reconstruction.

Keywords: Roux-en-Y anastomosis; double-balloon enteroscopy-assisted endoscopic retrograde cholangiopancreatography; gallbladder diseases; pancreaticoduodenectomy; short double-balloon enteroscope.

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