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. 2022 Jul;67(7):2882-2890.
doi: 10.1007/s10620-021-07342-2. Epub 2022 Jan 1.

Learning Curve of Endoscopic Retrograde Cholangiopancreatography Using Single-Balloon Enteroscopy

Kunihiro Hosono  1 , Takamitsu Sato  2 , Sho Hasegawa  2 , Yusuke Kurita  2 , Shin Yagi  2 , Akito Iwasaki  3 , Yuji Fujita  4 , Yusuke Sekino  5 , Emiko Tanida  6 , Takaomi Kessoku  2 , Shingo Kato  2 , Takuma Higurashi  2 , Masato Yoneda  2 , Kensuke Kubota  2 , Atsushi Nakajima  2
Affiliations

Learning Curve of Endoscopic Retrograde Cholangiopancreatography Using Single-Balloon Enteroscopy

Kunihiro Hosono et al. Dig Dis Sci. 2022 Jul.

Abstract

Background: Endoscopic retrograde cholangiopancreatography (ERCP) in patients with surgically altered anatomy is technically difficult. Extensive training is required to develop the ability to perform this procedure.

Aims: To investigate the learning curve of single-balloon-assisted enteroscopy ERCP (SBE-ERCP).

Methods: We conducted a retrospective, observational case series at a single center. We evaluated the SBE-ERCP procedures between April 2011 and February 2021. The main outcomes were the rate of reaching the target site and the success rate of the entire procedure. These parameters were additionally expressed as a learning curve.

Results: A total of 687 SBE-ERCP procedures were analyzed. The learning curve was analyzed in blocks of 10 cases. In this study, seven endoscopists, experts in conventional ERCP, were included. The overall SBE-ERCP procedural success rate was 92.2% (634/687 cases). Combining all data from individual endoscopists' evaluation periods, the insertion and success rates of the SBE-ERCP procedures gradually increased with increased experience performing SBE-ERCP. The insertion success rates for the number of SBE-ERCP cases (< 20, 21-30, > 30) were 82.9%, 92.9%, and 94.3%, respectively; the procedure success rates were 74.3%, 81.4%, and 92.9%, respectively. The endoscopists who had performed > 30 SBE-ERCP cases had a success rate of ≥ 90%.

Conclusions: Our results suggest that performing > 30 cases is one of the targets for conventional ERCP experts to become competent in performing SBE-ERCP in patients with a surgically altered anatomy.

Keywords: Endoscopic retrograde cholangiopancreatography; Learning curve; Single-balloon-assisted enteroscopy; Surgically altered anatomy.

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Conflict of interest statement

The authors declare that they have no conflict of interest.

Figures

Fig. 1
Fig. 1
All trainee performance in SBE-ERCP. The average success rate was calculated in blocks of 10 cases. A Probability of achieving an endoscope insertion plotted against the number of SBE-ERCPs performed. B Probability of achieving a procedure plotted against the number of SBE-ERCPs performed. The solid line shows the entire group, and the dotted line shows the standard deviations + 1 and − 1
Fig. 2
Fig. 2
Cap-assisted cannulation technique. A Complete observation of the ampulla of Vater by use of a cap in single-balloon enteroscopy. B In this view, the axis of the bile duct is tangential to the catheter (dashed arrow); it is difficult to cannulate to the bile duct. C First, the distance of the catheter tip and cap is kept constant. Next, by hooking the papilla with a cap by endoscopic manipulation, it becomes possible to align the bile duct axis and cannulate. D Successful cholangiography
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References

    1. Freeman ML, Guda NM. ERCP cannulation: a review of reported techniques. Gastrointest Endosc. 2005;61:112–125. doi: 10.1016/S0016-5107(04)02463-0. - DOI - PubMed
    1. Hintze RE, Adler A, Veltzke W, Abou-Rebyeh H. Endoscopic access to the papilla of Vater for endoscopic retrograde cholangiopancreatography in patients with billroth II or Roux-en-Y gastrojejunostomy. Endoscopy. 1997;29:69–73. doi: 10.1055/s-2007-1004077. - DOI - PubMed
    1. Wright BE, Cass OW, Freeman ML. ERCP in patients with long-limb Roux-en-Y gastrojejunostomy and intact papilla. Gastrointest Endosc. 2002;56:225–232. doi: 10.1016/S0016-5107(02)70182-X. - DOI - PubMed
    1. Elton E, Hanson BL, Qaseem T, Howell DA. Diagnostic and therapeutic ERCP using an enteroscope and a pediatric colonoscope in long-limb surgical bypass patients. Gastrointest Endosc. 1998;47:62–67. doi: 10.1016/S0016-5107(98)70300-1. - DOI - PubMed
    1. Haber GB. Double balloon endoscopy for pancreatic and biliary access in altered anatomy (with videos) Gastrointest Endosc. 2007;66:S47–S50. doi: 10.1016/j.gie.2007.06.017. - DOI - PubMed

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