Feasibility of Cap-Assisted Endoscopic Retrograde Cholangiopancreatography in Patients with Altered Gastrointestinal Anatomy
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Background/Aims: Endoscopic retrograde cholangiopancreatography (ERCP) is technically challenging in patients with altered gastrointestinal (GI) anatomy. We evaluated the feasibility of cap-assisted ERCP in patients with altered GI anatomy. Methods: The outcome of ERCP procedures (n=136) was analyzed in 78 patients with Billroth II (B-II) gastrectomy (n=72), Roux-en-Y total gastrectomy (n=4), and hepaticoduodenostomy (n=2). The intubation rate for reaching the papilla of Vater (POV), deep biliary cannulation rate, therapeutic interventions and procedure-related complications were analyzed. All of the procedures were conducted using a cap-fitted forward-viewing endoscope. Results: The rate of access to the POV was 97.1% (132/136). In cases with successful access, selective biliary cannulation was achieved in 98.5% (130/132) of the patients. The successful biliary cannulation rates were 100% (125/125) for B-II gastrectomy, 50% (2/4) for Roux-en-Y gastrectomy and 100% (3/3) for hepaticoduodenostomy. After selective biliary cannulation, therapeutic interventions, including stone extraction (n=57), sphincterotomy (n=54), stent placement (n=37), nasobiliary drainage (n=20), endoscopic papillary balloon dilatation (n=7) and mechanical lithotripsy (n=15), were performed successfully. The procedure-related complication rate was 8.8% (12/136), including immediate bleeding (5.9%, 8/136), pancreatitis (2.2%, 3/136), and perforation (0.7%, 1/136). There were no procedure-related deaths. Conclusions: Cap-assisted ERCP is efficient and safe in patients with altered GI anatomy.
Abstract
Background/Aims: Endoscopic retrograde cholangiopancreatography (ERCP) is technically challenging in patients with altered gastrointestinal (GI) anatomy. We evaluated the feasibility of cap-assisted ERCP in patients with altered GI anatomy. Methods: The outcome of ERCP procedures (n=136) was analyzed in 78 patients with Billroth II (B-II) gastrectomy (n=72), Roux-en-Y total gastrectomy (n=4), and hepaticoduodenostomy (n=2). The intubation rate for reaching the papilla of Vater (POV), deep biliary cannulation rate, therapeutic interventions and procedure-related complications were analyzed. All of the procedures were conducted using a cap-fitted forward-viewing endoscope. Results: The rate of access to the POV was 97.1% (132/136). In cases with successful access, selective biliary cannulation was achieved in 98.5% (130/132) of the patients. The successful biliary cannulation rates were 100% (125/125) for B-II gastrectomy, 50% (2/4) for Roux-en-Y gastrectomy and 100% (3/3) for hepaticoduodenostomy. After selective biliary cannulation, therapeutic interventions, including stone extraction (n=57), sphincterotomy (n=54), stent placement (n=37), nasobiliary drainage (n=20), endoscopic papillary balloon dilatation (n=7) and mechanical lithotripsy (n=15), were performed successfully. The procedure-related complication rate was 8.8% (12/136), including immediate bleeding (5.9%, 8/136), pancreatitis (2.2%, 3/136), and perforation (0.7%, 1/136). There were no procedure-related deaths. Conclusions: Cap-assisted ERCP is efficient and safe in patients with altered GI anatomy.
참고문헌 (21)
- Cotton PB, "ERCP", Gut, 18, pp.316~341 (1977)
- Baron TH, "Quality indicators for endoscopic retrograde cholangiopancreatography", Gastrointest Endosc, 63, pp.S29~S34 (2006)
- Forbes A, "ERCP and sphincterotomy after Billroth II gastrectomy", Gut, 25, pp.971~974 (1984)
- Osnes M, "Endoscopic retrograde cholangiography and endoscopic papillotomy in patients with a previous Billroth-II resection", Gut, 27, pp.1193~1198 (1986)
- Faylona JM, "Small-bowel perforations related to endoscopic retrograde cholangiopancreatography (ERCP) in patients with Billroth II gastrectomy", Endoscopy, 31, pp.546~549 (1999)
- Swarnkar K, "Diagnostic and therapeutic endoscopic retrograde cholangiopancreaticography after Billroth II gastrectomy: safe provision in a district general hospital", Ann R Coll Surg Engl, 87, pp.274~276 (2005)
- Bagci S, "Efficacy and safety of endoscopic retrograde cholangiopancreatography in patients with Billroth II anastomosis", Hepatogastroenterology, 52, pp.356~359 (2005)
- Cotton PB, "Income and outcome metrics for the objective evaluation of ERCP and alternative methods", Gastrointest Endosc, 56, pp.S283~S290 (2002)
- Lin LF, "ERCP in post-Billroth II gastrectomy patients: emphasis on technique", Am J Gastroenterol, 94, pp.144~148 (1999)
- Park CH, "Cap-assisted ERCP in patients with a Billroth II gastrectomy", Gastrointest Endosc, 66, pp.612~615 (2007)
- 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)
- Itoi T, "Single-balloon enteroscopy-assisted ERCP in patients with Billroth II gastrectomy or Roux-en-Y anastomosis (with video)", Am J Gastroenterol, 105, pp.93~99 (2010)
- Chu YC, "Double-balloon enteroscopy application in biliary tract disease-its therapeutic and diagnostic functions", Gastrointest Endosc, 68, pp.585~591 (2008)
- Nakahara K, "Therapeutic endoscopic retrograde cholangiopancreatography using an anterior obliqueviewing endoscope for bile duct stones in patients with prior Billroth II gastrectomy", J Gastroenterol, 44, pp.212~217 (2009)
- Koo HC, "The utility of a multibending endoscope for selective cannulation during ERCP in patients with a Billroth II gastrectomy", Gastrointest Endosc, 69, pp.931~934 (2009)
- Kaffes AJ, "Early institution of pre-cutting for difficult biliary cannulation: a prospective study comparing conventional vs. a modified technique", Gastrointest Endosc, 62, pp.669~674 (2005)
- Cotton PB, "Endoscopic sphincterotomy complications and their management: an attempt at consensus", Gastrointest Endosc, 37, pp.383~393 (1991)
- Kim MH, "Endoscopic retrograde cholangiopancreatography and needle-knife sphincterotomy in patients with Billroth II gastrectomy: a comparative study of the forwardviewing endoscope and the side-viewing duodenoscope", Endoscopy, 29, pp.82~85 (1997)
- Vandervoort J, "Risk factors for complications after performance of ERCP", Gastrointest Endosc, 56, pp.652~656 (2002)
- Cotton PB, "Risk factors for complications after ERCP: a multivariate analysis of 11,497 procedures over 12 years", Gastrointest Endosc, 70, pp.80~88 (2009)
- Christensen M, "Complications of ERCP: a prospective study", Gastrointest Endosc, 60, pp.721~731 (2004)