A multicenter, U.S. experience of single-balloon, double-balloon, and rotational overtube–assisted enteroscopy ERCP in patients with surgically altered pancreaticobiliary anatomy (with video) - 19/03/13
Reprint requests: Raj J Shah, MD, FASGE, AGAF, Associate Professor of Medicine, Division of Gastroenterology and Hepatology, University of Colorado School of Medicine, Mailstop F735, 1635 Aurora Ct Rm 2.031, Aurora, CO 80045Résumé |
Background |
Data on overtube-assisted enteroscopy to facilitate ERCP in patients with surgically altered pancreaticobiliary anatomy, or long-limb surgical bypass, is limited.
Objective |
To evaluate and compare ERCP success by using single-balloon (SBE), double-balloon (DBE), or rotational overtube enteroscopy.
Design |
Consecutive patients identified retrospectively.
Setting |
Eight U.S. referral centers.
Patients |
Long-limb surgical bypass patients with suspected pancreaticobiliary diseases.
Intervention |
Overtube-assisted enteroscopy ERCP.
Main Outcome Measurements |
Enteroscopy success: visualizing the pancreaticobiliary-enteric anastomosis or papilla. ERCP success: completing the intended pancreaticobiliary intervention. Clinical success: greater than 50% reduction in abdominal pain or level of hepatic enzyme elevations or resolution of jaundice.
Results |
From January 2008 through October 2009, 129 patients had 180 enteroscopy-ERCPs. Anatomy was Roux-en-Y: gastric bypass (n = 63), hepaticojejunostomy (n = 45), postgastrectomy (n = 6), Whipple procedure (n = 10), and other (n = 5). ERCP success was 81 of 129 (63%). Enteroscopy success: 92 of 129 (71%), of whom 81 of 92 (88%) achieved ERCP success. Reasons for ERCP failure (n = 48): afferent limb entered but pancreaticobiliary anastomosis and/or papilla not reached (n = 23), cannulation failure (n = 11), afferent limb angulation (n = 8), and jejunojejunostomy not identified (n = 6). Select interventions: anastomotic stricturoplasty (cautery ± dilation, n = 16), stone removal (n = 21), stent (n = 25), and direct cholangioscopy (n = 11). ERCP success rates were similar between Roux-en-Y gastric bypass and other long-limb surgical bypass and among SBE, DBE, and rotational overtube enteroscopy. Complications were 16 of 129, 12.4%.
Limitations |
Retrospective study.
Conclusion |
(1) ERCP is successful in nearly two-thirds of long-limb surgical bypass patients and in 88% when the papilla or pancreaticobiliary-enteric anastomosis is reached. (2) Enteroscopy success in long-limb surgical bypass is similar among SBE, DBE, and rotational overtube enteroscopy methods. (3) Referral of long-limb surgical bypass patients who require ERCP to high-volume institutions may be considered before more invasive percutaneous or surgical alternatives.
Le texte complet de cet article est disponible en PDF.Abbreviations : SBE, DBE
Plan
| DISCLOSURE: R. Shah received a consulting and educational grant from Cook and educational grants from Olympus and Pentax. A. Ross received honoraria from Olympus and Cook. R. Kozarek received educational grants from Cook and Olympus. D. Howell is a consultant for Olympus and has a consultant and royalty agreement with Cook. S. Jonnalagadda is a speaker for Olympus. D. Morgan received a research grant from Spirus, Inc. P. Akerman is a consultant for Spirus, Inc. No other financial relationships relevant to this publication were disclosed. |
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| If you would like to chat with an author of this article, you may contact Dr Shah at raj.shah@ucdenver.edu. |
Vol 77 - N° 4
P. 593-600 - avril 2013 Retour au numéro
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