A new method to identify the afferent limb in balloon enteroscopy-assisted ERCP: Retention of gel mixed with contrast medium under fluoroscopy

Fukushi, Koh; Hoshi, Koki; Abe, Yoko; Yamamiya, Akira; Nagashima, Kazunori; Irisawa, Atsushi

doi:10.1055/a-1974-9344

Cited by 2 publications

(1 citation statement)

References 4 publications

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“…It was shown that device-assisted enteroscopy, using either single-balloon, double-balloon or spiral enteroscopy, allows one to perform ERCP in patients with different types of surgically altered anatomy when the biliopancreatic system is inaccessible with conventional duodenoscopes [10]. However, insertion of the enteroscope and identification and intubation of the afferent or biliopancreatic limb rely on fluoroscopic guidance, leading to additional patient radiation exposure during enteroscope insertion before starting the actual ERCP procedure in patients with surgically altered anatomy [11]. Fluoroscopy not only serves to identify the correct intestinal limb, which cannot always be identified based on the endoscopic aspect only, it also helps to estimate the remaining distance to the papilla or the hepaticojejunostomy [12].…”

Section: Introductionmentioning

confidence: 99%

Patient Radiation Exposure during Enteroscopy-Assisted Endoscopic Retrograde Cholangiopancreatography in Surgically Altered Anatomy (with Video)

Monino,

Moreels

2024

Diagnostics

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Background: Fluoroscopy must be used cautiously during endoscopic retrograde cholangiopancreatography (ERCP). Radiation exposure data in patients with surgically altered anatomy undergoing enteroscopy-assisted ERCP (EA-ERCP) are scarce. Methods: 34 consecutive EA-ERCP procedures were compared with 68 conventional ERCP (C-ERCP) procedures. Patient and procedure characteristics and radiation data were collected. Results: Surgical reconstructions were gastrojejunostomy, Roux-en-Y hepaticojejunostomy, Roux-en-Y total gastrectomy, Roux-en-Y gastric bypass and Whipple’s duodenopancreatectomy. Procedures were restricted to biliary indications. Mean fluoroscopy time was comparable in both groups (370 ± 30 s EA-ERCP vs. 393 ± 40 s C-ERCP, p = 0.7074), whereas total mean radiation dose was lower in EA-ERCP (83 ± 6 mGy) compared to C-ERCP (110 ± 11 mGy, p = 0.0491) and dose area product (DAP) was higher in EA-ERCP (2216 ± 173 µGy*m2) compared to C-ERCP (1600 ± 117 µGy*m2, p = 0.0038), as was total procedure time (77 ± 5 min vs. 39 ± 3 min, p < 0.0001). Enteroscope insertion to reach the bile duct during EA-ERCP took 28 ± 4 min, ranging from 4 to 90 min. These results indicate that C-ERCP procedures are generally more complex, needing magnified fluoroscopy, whereas EA-ERCP procedures take more time for enteroscope insertion under wide field fluoroscopic guidance (increased DAP) with less complex ERCP manipulation (lower total radiation dose). Conclusions: Radiation exposure during EA-ERCP in surgically altered anatomy is different as compared to C-ERCP. EA-ERCP takes longer with a higher DAP because of the enteroscope insertion, but with lower total radiation dose because these ERCP procedures are usually less complex.

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Section: Introductionmentioning

confidence: 99%