Analysis of the factors involved in procedural failure: Endoscopic retrograde cholangiopancreatography using a short‐type single‐balloon enteroscope for patients with surgically altered gastrointestinal anatomy

Tanisaka, Yuki; Ryozawa, Shomei; Mizuide, Masafumi; Harada, Maiko; Fujita, Akashi; Ogawa, Tomoya; Nonaka, Kouichi; Tashima, Tomoaki; Araki, Ryuichiro

doi:10.1111/den.13414

Cited by 42 publications

(59 citation statements)

References 29 publications

(59 reference statements)

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“…Only one retrospective study [39] compared long-type, not short-type, single and double balloon endoscopes for ERCP, and demonstrated similar outcomes between two scopes. Recently, two studies [38,40] reported clinical outcomes of a short-type single balloon endoscope for ERCP with technical success rates of 81.8 % and 85.9 % and AE rates of 5.9 % and 8.4 %, respectively, which is comparable to our study results. Although there were no studies comparing two short-type balloon endoscopes, it is reasonable to say the type of balloon endoscopes can be selected depending on the local expertise.…”

Section: Methodssupporting

confidence: 90%

Feasibility of balloon endoscope-assisted endoscopic retrograde cholangiopancreatography for the elderly

et al. 2020

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Background and study aims Endoscopic retrograde cholangiopancreatography (ERCP) for patients with surgically altered anatomy is challenging. Recently, balloon endoscopy has been shown to facilitate ERCP for this population with a high technical success rate, but adverse events (AEs) are not uncommon. Compared to non-elderly patients, elderly patients may be at higher risk of AEs due to underlying comorbidities. The current study aimed to evaluate the feasibility of balloon endoscope-assisted ERCP (BE-ERCP) for the elderly. Patients and methods We retrospectively identified patients who underwent BE-ERCP between January 2010 and September 2019. For patients who underwent multiple procedures during the study period, the first session was analyzed. Early AEs associated with BE-ERCP were compared between elderly (≥ 75 years) and non-elderly patients. Results A total of 1,363 BE-ERCP procedures were performed, and 568 patients (211 elderly and 357 non-elderly) were included for the analyses. Technical success rates were high in both the elderly and non-elderly groups (80 % vs. 80 %, respectively). The rates of early AEs were similar between the groups (12 % vs. 9.0 % in the elderly and non-elderly group, respectively; P = 0.31). The mltivariable-adjusted odds ratio for early AEs comparing elderly to non-elderly patients was 1.36 (95 % confidence interval, 0.74–2.51; P = 0.32). Specifically, we did not observe between-group differences in rates of gastrointestinal perforation (2.4 % vs. 2.8 % in elderly and non-elderly groups, respectively; P = 0.99) and aspiration pneumonia (1.9 % vs. 0.6 %, P = 0.20). Conclusions BE-ERCP is a feasible procedure for elderly individuals with surgically altered anatomy.

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Section: Methodssupporting

confidence: 90%

Feasibility of balloon endoscope-assisted endoscopic retrograde cholangiopancreatography for the elderly

et al. 2020

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“…In patients with SAA who have undergone Whipple reconstruction and other procedures after PD, the rendezvous technique is mainly carried out to treat stricture of the PD site . Although it can be treated with BAE, the opening of the site of pancreatic duct anastomosis is often difficult to identify with BAE because it is small and scarred . Thus, the main pancreatic duct is dilated and punctured.…”

Section: Therapeutic Proceduresmentioning

confidence: 99%

“…16 Although it can be treated with BAE, the opening of the site of pancreatic duct anastomosis is often difficult to identify with BAE because it is small and scarred. 43 Thus, the main pancreatic duct is dilated and punctured. A guidewire is guided through the anastomotic site into the jejunum.…”

Section: Rendezvous Techniquementioning

confidence: 99%

Interventional endoscopic ultrasonography in patients with surgically altered anatomy: Techniques and literature review

Katanuma

Hayashi

Kin

et al. 2019

Digestive Endoscopy

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There are various reconstruction techniques that are used after upper gastrointestinal surgery. In recent years, opportunities for endoscopic diagnosis and treatment have been increasing in patients undergoing gastrointestinal surgery. With the advent of interventional endoscopic ultrasound (IV‐EUS), various procedures have been developed mainly for patients in whom endoscopic retrograde cholangiopancreatography is difficult to carry out. Indications for such procedures are expanding. IV‐EUS for surgically altered anatomy (SAA) includes EUS‐guided fine‐needle aspiration, biliary interventions (e.g. biliary drainage, treatment of bile duct stricture, removal of bile duct stones, and the rendezvous technique), and pancreatic interventions (e.g. rendezvous technique after Whipple surgery). In addition, there have been reports of various EUS‐related procedures using a forward‐viewing curved linear‐array echoendoscope that are carried out for postoperative intestinal tract reconstruction. Although interventional EUS is a useful therapeutic procedure for SAA, there are still no dedicated devices, and standardization of the procedure is warranted.

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“…Similarly, using a duodenoscope and performing bile duct cannulation and subsequent treatments are technically more difficult in patients with altered anatomy than in those with normal anatomy. A short‐type single‐balloon enteroscope, with a working length of 152 cm and working channel of 3.2‐mm, was developed to increase the number of devices that can be used during ERCP in patients with surgically altered gastrointestinal anatomy and was reported to be useful . However, selective biliary cannulation through the papilla is difficult in patients with surgically altered gastrointestinal anatomy than in those with normal anatomy because the appearance of the papilla is a reversal of its usual appearance in normal anatomy, the position is frequently tangential, and a forward‐viewing endoscope without an elevator is required.…”

Section: Introductionmentioning

confidence: 99%

“…A short-type single-balloon enteroscope, with a working length of 152 cm and working channel of 3.2-mm, was developed to increase the number of devices that can be used during ERCP in patients with surgically altered gastrointestinal anatomy and was reported to be useful. [1][2][3][4][5] However, selective biliary cannulation through the papilla is difficult in patients with surgically altered gastrointestinal anatomy than in those with normal anatomy because the appearance of the papilla is a reversal of its usual appearance in normal anatomy, the position is frequently tangential, and a forward-viewing endoscope without an elevator is required. Recently, the use of a pancreatic duct (PD) stent to facilitate selective biliary cannulation in patients with normal anatomy was described.…”

Section: Introductionmentioning

confidence: 99%

Novel technique using pancreatic duct stent facilitates difficult biliary cannulation in patients with Roux‐en‐Y anatomy (with video)

et al. 2019

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Endoscopic retrograde cholangiopancreatography (ERCP) in patients with surgically altered gastrointestinal anatomy has been reported to be useful. However, selective biliary cannulation through the papilla is difficult in cases with surgically altered gastrointestinal anatomy. Herein, we report a successful biliary cannulation using a pancreatic duct (PD) stent in patients with Roux‐en‐Y anatomy. A 70‐year‐old man who underwent total gastrectomy with Roux‐en‐Y anatomy was admitted to our hospital with jaundice due to recurrence of gastric cancer. ERCP was performed for biliary drainage. We approached the papilla using a short‐type single‐balloon enteroscope (SIF‐H290; Olympus Medical Systems). Because the papilla was positioned tangentially, it was difficult to adjust the catheter in the direction of the bile duct. As only a PD could be cannulated, we placed a guidewire in the PD. Although we attempted the double‐guidewire technique using a guidewire placed in PD, selective biliary cannulation was difficult. Therefore, we placed a PD stent 5Fr‐5cm (Geenen, Pancreatic Stent Sets, Cook Medical, Bloomington, IN, USA) to assist biliary cannulation. We inserted a catheter crossing the PD stent. With this, selective biliary cannulation was successful. We successfully performed selective biliary cannulation using the PD stent as we were able to fix the papilla, straighten the common channel and the axis of the bile duct, and not restrict scope movement by not using the PD guidewire placement method. This novel technique using a PD stent appears to be useful in patients with surgically altered gastrointestinal anatomy.

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Analysis of the factors involved in procedural failure: Endoscopic retrograde cholangiopancreatography using a short‐type single‐balloon enteroscope for patients with surgically altered gastrointestinal anatomy

Cited by 42 publications

References 29 publications

Feasibility of balloon endoscope-assisted endoscopic retrograde cholangiopancreatography for the elderly

Feasibility of balloon endoscope-assisted endoscopic retrograde cholangiopancreatography for the elderly

Interventional endoscopic ultrasonography in patients with surgically altered anatomy: Techniques and literature review

Novel technique using pancreatic duct stent facilitates difficult biliary cannulation in patients with Roux‐en‐Y anatomy (with video)

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