Clinical evaluation of double-channel gastroscope for endoscopic retrograde cholangiopancreatography in patients with Billroth II gastrectomy

Wang, Sheng; Liu, Wen; Sun, Siyu; Wang, Guoxin; Xiang, Liangzhong; Ge, Nan; Guo, Jintao

doi:10.5114/pg.2016.61370

Cited by 2 publications

(4 citation statements)

References 13 publications

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“…In our study, the favorable results of forward-viewing gastroscope in comparison to the side-viewing duodenoscope can result from the fact that we used a therapeutic gastroscope with an extra-large channel associated sometimes with a transparent cap fitted to the distal end, facilitating not only afferent loop intubation and progression due to its flexibility and good visual field, but also deep cannulation due to its large working channel and use of cap. Recently, two retrospective cohorts of 18 and 46 patients with Billroth II gastrectomy that underwent ERCP using therapeutic double-channel gastroscope reported afferent loop intubation of 83% and papilla cannulation of 100% [ 20 , 21 ].…”

Section: Discussionmentioning

confidence: 99%

“…Indeed, the non-statistically significant lower adverse events rate with the forward-viewing gastroscope may traduce the small sample size. However, the majority of the studies published to date have smaller sample sizes [ 7 , 8 , 10 , 11 , 19 , 20 , 21 ]. Moreover, this study was performed in a tertiary referral center with expertise in ERCP, which could have positively impacted the results, stressing the need to refer these patients to expert centers.…”

Section: Discussionmentioning

confidence: 99%

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Side-Viewing Duodenoscope versus Forward-Viewing Gastroscope for Endoscopic Retrograde Cholangiopancreatography in Billroth II Gastrectomy Patients

Sá

Chaves

Sousa³

et al. 2022

GE Port J Gastroenterol

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Introduction: Endoscopic retrograde cholangiopancreatography (ERCP) in patients with Billroth II gastrectomy is still a challenging procedure. The optimal approach, namely the type of endoscope and sphincter management, has yet to be defined. Aim: To compare the efficacy and safety of forward-viewing gastroscope and the side-viewing duodenoscope in ERCP of patients with Billroth II gastrectomy. Methods: We conducted a retrospective, single-center cohort study of consecutive patients with Billroth II gastrectomy submitted to ERCP in an expert center for ERCP between 2005 and 2021. The outcomes assessed were: papilla identification, deep biliary cannulation, and adverse events (AEs). Multivariate analysis was performed to evaluate potential associations and predictors of the main outcomes. Results: We included 83 patients with a median age of 73 (IQR 65–81) years. ERCP was performed using side-viewing duodenoscope in 52 and forward-viewing gastroscope in 31 patients. Patients’ characteristics were similar in the two groups. The global rate of papilla identification was 66% (n = 55). The rate of deep cannulation was 58% considering all patients and 87% in the subgroup of patients in which the papilla major was identified. Cannulation was performed with standard methods in 65% of cases and with needle-knife fistulotomy in 35%. AEs occurred in 4 patients. There was no difference between duodenoscope and gastroscope in papilla identification (64% [95% CI: 51–77] vs. 71% [55–87]). Although not statistically significant, duodenoscope had a lower deep cannulation rate when considering all patients (52% [15–39] vs. 68% [7–35]) and a higher AEs rate (8% [1–15] vs. 0% [0–1]). In a multivariate analysis, the use of gastroscope significantly increased the deep cannulation rate (OR = 152.62 [2.5–9,283.6]). Conclusion: This study demonstrates that forward-viewing gastroscope is at least as effective and safe as side-viewing duodenoscope for ERCP in patients with Billroth II gastrectomy. Moreover, our study showed that gastroscope is an independent predictor of successful cannulation.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Side-Viewing Duodenoscope versus Forward-Viewing Gastroscope for Endoscopic Retrograde Cholangiopancreatography in Billroth II Gastrectomy Patients

Sá

Chaves

Sousa³

et al. 2022

GE Port J Gastroenterol

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“…Recently, the advent of new types of endoscopes, such as a dual lumen or multiple bending endoscope, has allowed successful afferent loop intubation and selective cannulation[10,28]. The use of dual lumen endoscope has potential advantage that the cooperation of two instruments through different channels can facilitate papillary cannulation in cases with difficult anatomy such as periampullary diverticulum and surgical altered anatomy.…”

Section: Discussionmentioning

confidence: 99%

“…The use of dual lumen endoscope has potential advantage that the cooperation of two instruments through different channels can facilitate papillary cannulation in cases with difficult anatomy such as periampullary diverticulum and surgical altered anatomy. Unfortunately, the success rate of these procedures is not significantly higher than that of conventional side-viewing endoscopy, easily available forward-viewing endoscopy or standard colonoscopy (dual lumen endoscope, 82.8%; multiple bending endoscope, 92.9% vs conventional side-viewing endoscopy, 93.8%-97.5%; forward-viewing endoscopy, 95.4%; standard colonoscopy, 96.2%)[9,10,17-19,28,29]. Until now, there has been no large-scale retrospective cohort study or prospective comparative study.…”

Section: Discussionmentioning

confidence: 99%

Recent advances in endoscopic retrograde cholangiopancreatography in Billroth II gastrectomy patients: A systematic review

Park¹,

Song²

2019

WJG

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BACKGROUND Endoscopic retrograde cholangiopancreatography (ERCP) in patients with Billroth II gastrectomy has been considered a challenging procedure due to the surgically altered gastrointestinal anatomy. However, there has been a paucity of comparative studies regarding ERCP in Billroth II gastrectomy cases because of procedure-related morbidity and mortality and practical and ethical limitations. This systematic and comprehensive review was performed to obtain a recent perspective on ERCP in Billroth II gastrectomy patients. AIM To systematically review the literature regarding ERCP in Billroth II gastrectomy patients. METHODS A systematic review was performed on the literature published between May 1975 and January 2019. The following electronic databases were searched: PubMed, EMBASE, and Cochrane Library. The outcomes of successful afferent loop intubation and successful selective cannulation and occurrence of adverse events were assessed. RESULTS A total of 43 studies involving 2669 patients were included. The study designs were 36 (83.7%) retrospective cohort studies, 4 (9.3%) retrospective comparative studies, 2 (4.7%) prospective comparative studies, and 1 (2.3%) prospective cohort study. Of a total of 2669 patients, there were 1432 cases (55.6%) of side-viewing endoscopy, 664 (25.8%) cases of forward-viewing endoscopy, 171 (6.6%) cases of balloon-assisted enteroscopy, 169 (6.6%) cases of anterior oblique-viewing endoscopy, 64 (2.5%) cases of dual-lumen endoscopy, 31 (1.2%) cases of colonoscopy, and 14 (0.5%) cases of multiple bending endoscopy. The overall success rate of afferent loop intubation was 91.3% (2437/2669), and the overall success rate of selective cannulation was 87.9% (2346/2437). A total of 195 cases (7.3%) of adverse events occurred. The success rates of afferent loop intubation and the selective cannulation rate for each type of endoscopy were as follows: side-viewing endoscopy 98.2% and 95.3%; forward-viewing endoscopy 97.4% and 95.2%; balloon-assisted enteroscopy 95.4% and 97.5%; oblique-viewing endoscopy 94.1% and 97.5%; and dual-lumen endoscopy 82.8% and 100%, respectively. The rate of bowel perforation was slightly higher in side-viewing endoscopy (3.6%) and balloon-assisted enteroscopy (4.1%) compared with forward-viewing endoscopy (1.7%) and anterior oblique-viewing endoscopy (1.2%). Mortality only occurred in side-viewing endoscopy ( n = 9, 0.6%). CONCLUSION The performance of ERCP in the Billroth II gastrectomy population has been improving with choice of various type of endoscope and sphincter management. More comparative studies are needed to determine the optimal strategy to perform safe and effective ERCP in Billroth II gastrectomy patients.

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Clinical evaluation of double-channel gastroscope for endoscopic retrograde cholangiopancreatography in patients with Billroth II gastrectomy

Cited by 2 publications

References 13 publications

Side-Viewing Duodenoscope versus Forward-Viewing Gastroscope for Endoscopic Retrograde Cholangiopancreatography in Billroth II Gastrectomy Patients

Side-Viewing Duodenoscope versus Forward-Viewing Gastroscope for Endoscopic Retrograde Cholangiopancreatography in Billroth II Gastrectomy Patients

Recent advances in endoscopic retrograde cholangiopancreatography in Billroth II gastrectomy patients: A systematic review

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