Accuracy of carbon dioxide insufflation for endoscopic retrograde cholangiopancreatography using double-balloon endoscopy

Abstract

BACKGROUND Retrograde cholangiopancreatography using double-balloon endoscopic retrograde cholangiography (DBERC) is a valuable technique to treat biliary stone and jejunobiliary anastomotic stenosis in patients with altered gastrointestinal anatomy. The accurate selection of the route at the anastomosis branch is one of the most important factors in reaching the target in a timely manner. AIM To determine the accuracy of carbon dioxide insufflation enterography (CDE) at the branch for selecting the correct route during DBERC. METHODS We enrolled 52 consecutive patients scheduled for DBERC at our institution from June 2015 to November 2017. Route selection via two methods (visual observation and CDE) was performed in each patient. We determined the correct rate of route selection using CDE. RESULTS Thirty-three patients had a jejunojejunal anastomosis and 19 patients had a gastrojejunal anastomosis. The therapeutic target region was reached in 50 patients. The mean procedure times from the teeth to the target (total insertion time), from the teeth to the branch, and from the branch to the target, and the mean total examination time were 15.2, 5.0, 8.2, and 60.3 min, respectively. The rate of correct route selection using visual observation and CDE were 36/52 (69.2%) and 48/52 (92.3%), respectively ( P = 0.002). The rate of correct route selection using CDE in patients with a jejunojejunal anastomosis was 29/33 (87.8%), and the rate in patients with a gastrojejunal anastomosis was 19/19 (100%). CONCLUSION CDE is helpful in selecting the route at the branch in the anastomosis for more timely access to the target in patients with altered gastrointestinal anatomy undergoing DBERC.

CO2 enterography in endoscopic retrograde cholangiography using double‐balloon endoscopy: A randomized clinical trial

“…The correct rate of route selection by visual observation in daily clinical practice was approximately 60%. Our previous data of correct route selection was 92.3% in the CDE group 20 . We anticipated that an additional 35% of correct rate could be expected in CDE compared with visual observation according to our preliminary results 20 .…”

“…Our previous data of correct route selection was 92.3% in the CDE group 20 . We anticipated that an additional 35% of correct rate could be expected in CDE compared with visual observation according to our preliminary results 20 . With a statistical power of 0.80 and a two‐sided significance level of 0.05, the minimal sample number was 25 patients in each group.…”

“…To confirm the validity of the CDE for DBERC shown in the previous report, 20 the CDE and conventional visual methods were compared using an RCT that included stratification factors, types of reconstructed bowel, and DBERC experience at the first attempt. Some of BII reconstruction without gastrectomy and RY reconstruction were considered difficult to access the target in DBERC 6,7 …”

“…Any endoscopic procedure has a potential risk of complications; however, it is important to find a way to reduce them and it is necessary to prevent excessive volume of gas from being pumped into the bile ducts, and for this reason, it would be even better to shorten the examination time. As for the amount of gas insufflation into the bile duct, the CDE method in this study only involves CO 2 insufflation for 10 s at the maximum, and no gas is stored in the bile duct during route selection; therefore, the amount of insufflation does not induce a particular problem 20 . CDE appears to help reduce the insertion time and total examination time due to the success of the initial route selection.…”

“…We previously reported the effectiveness of carbon dioxide insufflation enterography (CDE), which is a method for selecting a reconstructed intestinal tract using carbon dioxide (CO 2 ) 20 . The results of this retrospective study indicated that the rate of correct route selection performed by experts was 69.2% in the conventional visual observation group ( vs 92.3% in the CDE group).…”