Impact of Scope Exchange from a Long Single Balloon Enteroscope to a Gastroscope during Enteroscopy-Assisted Endoscopic Retrograde Cholangiopancreatography in Patients with Surgically Altered Anatomy
1
조회
0
다운로드
1
인용
0
참고문헌
키워드
초록
Background/Aims: Endoscopic retrograde cholangiopancreatography (ERCP) in patients with surgically altered anatomy (SAA) is challenging to gastrointestinal endoscopists. The aim of this study was to evaluate the impact of scope exchange from a long single balloon enteroscope (SBE) to a gastroscope during SBE-assisted ERCP (SBE-ERCP) in patients with SAA. Methods: Patients who underwent SBE-ERCP between February 2019 and October 2020 were retrospectively identified. Intubation success, scope exchange success, cannulation success, and therapeutic success were analyzed along with complications. Results: Fifty-six patients with various SAAs underwent SBE-ERCP procedures, including Billroth II subtotal gastrectomy (B-II, n=13), pylorus-preserving pancreato-duodenectomy (PPPD, n=6), Roux-en-Y hepaticojejunostomy (REY HJ, n=4), and total gastrectomy with REY anastomosis (TG REY, n=33). Overall intubation, cannulation, and therapeutic success rates were 89.3%, 82.1%, and 82.1%, respectively. Therapeutic success rates did not differ significantly among the type of SAA. Successful scope exchange rate after successful intubation was significantly higher in native papilla (B-II and TG REY, 83.3%, 35/42) compared to bilioenteric anastomosis (PPPD and REY HJ, 0%, 0/8, p<0.001). Intubation success, scope exchange, and cannulation success were associated with therapeutic success (p<0.001). In multivariate analysis, successful scope exchange was the only factor related to cannulation success (p=0.02). The major complication rate was 1.8% (one perforation). Conclusions: SBE-ERCP is a safe and effective procedure to treat biliary problems in patients with SAA. Successful scope exchange may lead to higher therapeutic success by way of cannulation success.
Abstract
Background/Aims: Endoscopic retrograde cholangiopancreatography (ERCP) in patients with surgically altered anatomy (SAA) is challenging to gastrointestinal endoscopists. The aim of this study was to evaluate the impact of scope exchange from a long single balloon enteroscope (SBE) to a gastroscope during SBE-assisted ERCP (SBE-ERCP) in patients with SAA. Methods: Patients who underwent SBE-ERCP between February 2019 and October 2020 were retrospectively identified. Intubation success, scope exchange success, cannulation success, and therapeutic success were analyzed along with complications. Results: Fifty-six patients with various SAAs underwent SBE-ERCP procedures, including Billroth II subtotal gastrectomy (B-II, n=13), pylorus-preserving pancreato-duodenectomy (PPPD, n=6), Roux-en-Y hepaticojejunostomy (REY HJ, n=4), and total gastrectomy with REY anastomosis (TG REY, n=33). Overall intubation, cannulation, and therapeutic success rates were 89.3%, 82.1%, and 82.1%, respectively. Therapeutic success rates did not differ significantly among the type of SAA. Successful scope exchange rate after successful intubation was significantly higher in native papilla (B-II and TG REY, 83.3%, 35/42) compared to bilioenteric anastomosis (PPPD and REY HJ, 0%, 0/8, p<0.001). Intubation success, scope exchange, and cannulation success were associated with therapeutic success (p<0.001). In multivariate analysis, successful scope exchange was the only factor related to cannulation success (p=0.02). The major complication rate was 1.8% (one perforation). Conclusions: SBE-ERCP is a safe and effective procedure to treat biliary problems in patients with SAA. Successful scope exchange may lead to higher therapeutic success by way of cannulation success.
참고문헌 (23)
- Chahal P, "Endoscopic retrograde cholangiopancreatography in post-Whipple patients", Endoscopy, 38, pp.1241~1245 (2006)
- Skinner M, "ERCP with the overtube-assisted enteroscopy technique : a systematic review", Endoscopy, 46, pp.560~572 (2014)
- Nakai Y, "Endoscopic management of bile duct stones in patients with surgically altered anatomy", Dig Endosc, 30(Suppl 1), pp.67~74 (2018)
- Itoi T, "Single-balloon enteroscopyassisted ERCP in patients with Billroth II gastrectomy or Roux-en-Y anastomosis(with video)", Am J Gastroenterol, 105, pp.93~99 (2010)
- Cotton PB, "A lexicon for endoscopic adverse events : report of an ASGE workshop", Gastrointest Endosc, 71, pp.446~454 (2010)
- Inamdar S, "Systematic review and meta-analysis of single-balloon enteroscopy-assisted ERCP in patients with surgically altered GI anatomy", Gastrointest Endosc, 82, pp.9~19 (2015)
- Trindade AJ, "Use of a cap in single-balloon enteroscopy-assisted endoscopic retrograde cholangiography", Endoscopy, 47, pp.453~456 (2015)
- Azeem N, "Use of a singleballoon enteroscope compared with variable-stiffness colonoscopes for endoscopic retrograde cholangiography in liver transplant patients with Roux-en-Y biliary anastomosis", Gastrointest Endosc, 77, pp.568~577 (2013)
- Lennon AM, "Spiral assisted ERCP is equivalent to single balloon assisted ERCP in patients with Roux-en-Y anatomy", Dig Dis Sci, 57, pp.1391~1398 (2012)
- Saleem A, "Endoscopic retrograde cholangiopancreatography using a single-balloon enteroscope in patients with altered Roux-en-Y anatomy", Endoscopy, 42, pp.656~660 (2010)
- Shah RJ, "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)", Gastrointest Endosc, 77, pp.593~600 (2013)
- Kawamura T, "Does singleballoon enteroscopy contribute to successful endoscopic retrograde cholangiopancreatography in patients with surgically altered gastrointestinal anatomy", ISRN Gastroenterol, 2013, pp.214958~ (2013)
- Osoegawa T, "Improved techniques for double-balloon-enteroscopy-assisted endoscopic retrograde cholangiopancreatography", World J Gastroenterol, 18, pp.6843~6849 (2012)
- Cho S, "‘Short’ double-balloon enteroscope endoscopic retrograde cholangiopancreatography in patients with a surgically altered upper gastrointestinal tract", Can J Gastroenterol, 25, pp.615~619 (2011)
- Shimatani M, "Effective"short"double-balloon enteroscope for diagnostic and therapeutic ERCP in patients with altered gastrointestinal anatomy : a large case series", Endoscopy, 41, pp.849~854 (2009)
- Siddiqui AA, "Utility of the short double-balloon enteroscope to perform pancreaticobiliary interventions in patients with surgically altered anatomy in a US multicenter study", Dig Dis Sci, 58, pp.858~864 (2013)
- Itoi T, "Long-and short-type doubleballoon enteroscopy-assisted therapeutic ERCP for intact papilla in patients with a Roux-en-Y anastomosis", Surg Endosc, 25, pp.713~721 (2011)
- Shimatani M, "Endoscopic approaches for pancreatobiliary diseases in patients with altered gastrointestinal anatomy", Dig Endosc, 26(Suppl 1), pp.70~78 (2014)
- Wang AY, "Single-balloon enteroscopy effectively enables diagnostic and therapeutic retrograde cholangiography in patients with surgically altered anatomy", Gastrointest Endosc, 71, pp.641~649 (2010)
- Kianička B, "Single balloon enteroscopy for endoscopic retrograde cholangiography in patients with Roux-en-Y hepaticojejuno anastomosis", World J Gastroenterol, 19, pp.8047~8055 (2013)
- Tomizawa Y, "Single balloon enteroscopy(SBE)assisted therapeutic endoscopic retrograde cholangiopancreatography(ERCP)in patients with roux-eny anastomosis", Dig Dis Sci, 59, pp.465~470 (2014)
- ASGE Technology Committee, "Devices and techniques for ERCP in the surgically altered GI tract", Gastrointest Endosc, 83, pp.1061~1075 (2016)
- Moreels TG, "Altered anatomy : enteroscopy and ERCP procedure", Best Pract Res Clin Gastroenterol, 26, pp.347~357 (2012)