Endoscopic retrograde cholangiopancreatography in patients with surgically altered anatomy

Wang, Fei; Xu, Boming; Li, Quanpeng; Zhang, Xun; Jiang, Guomin; Ge, Xianxiu; Nie, Junjie; Zhang, Xiuyun; Wu, Ping; Ji, Jie; Ma, Lin

doi:10.1097/md.0000000000005743

Cited by 30 publications

(40 citation statements)

References 30 publications

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“…Endoscopic retrograde cholangiopancreatography (ERCP) is a valuable procedure which combines endoscopy and fluoroscopy for the management of pancreatobiliary diseases . It was first performed in 1968 by McCune, Shorb, and Moscovitz and few years later ERCP with sphincterotomy and removal of a common bile duct stone was reported in 1974 . ERCP is currently an established procedure in the field of therapeutic digestive endoscopy.…”

Section: Introductionmentioning

confidence: 99%

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Challenges of endoscopic retrograde cholangiopancreatography in patients with Billroth II gastrointestinal anatomy: A review article

Pribadi

Rani

Abdullah

2019

J of Digest Diseases

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Endoscopic retrograde cholangiopancreatography (ERCP) is a combination of endoscopy and fluoroscopy that is commonly used in the management of pancreatobiliary diseases. ERCP can be challenging if performed in surgically altered anatomy, such as a Billroth II reconstruction, compared with native anatomy and usually has a lower success rate. We identified five emerging challenges in such patients. These are the choice of endoscope, the identification of afferent loop, reaching the duodenal stump, cannulation in the reverse position, and endoscopic sphincterotomy. Performing ERCP in patients with a Billroth II reconstruction needs adequate knowledge, proper skill, and experience to achieve a good clinical outcome. K E Y W O R D SBillroth II, endoscopic retrograde cholangiopancreatography, gastroenterostomy, surgically altered anatomy

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Section: Introductionmentioning

confidence: 99%

“…The success rate of ERCP in native gastrointestinal anatomy is higher than that in patients with a surgically altered anatomy, such as Billroth I and Billroth II reconstruction . Billroth I anatomy results from the anastomosis of the gastric remainder with the duodenum after distal gastric resection.…”

Section: Introductionmentioning

confidence: 99%

Challenges of endoscopic retrograde cholangiopancreatography in patients with Billroth II gastrointestinal anatomy: A review article

Pribadi

Rani

Abdullah

2019

J of Digest Diseases

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“…In the treatment of CBDS, ERCP has a very high application value in the treatment of difficult and complex CBDS due to its characteristics of small trauma, short operation time, less complications and good prognosis. [ 3 , 4 , 14 ] However, CBDS are likely to recur within 6 months after ERCP treatment, which has become a difficult problem for clinicians. At present, there are different reports about the recurrence rate of CBDS after ERCP.…”

Section: Discussionmentioning

confidence: 99%

“…At present, ERCP is the first choice for the treatment of CBDS. [ 3 , 4 ] However, ERCP has complications such as recurrence of CBDS, postoperative pancreatitis, bleeding and infection, among which the most common long-term complications are stone recurrence. [ 5 – 7 ] At present, there are different reports on the recurrence rate of CBDS after ERCP, ranging from 4% to 24%.…”

Section: Introductionmentioning

confidence: 99%

Risk factors of stone recurrence after endoscopic retrograde cholangiopancreatography for common bile duct stones

2020

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To explore the risk factors related to the recurrence of common bile duct stones (CBDS) after endoscopic retrograde cholangiopancreatography (ERCP), so as to provide reference for reducing the recurrence of CBDS after ERCP. The clinical data of 385 patients with CBDS treated by ERCP from March 2012 to May 2016 were collected. According to the diagnostic criteria of recurrence of CBDS, the patients were divided into recurrence group and control group. The general information of the patients, personal history, past history, and surgical-related information were collected. Univariate analysis and multivariate logistic regression analysis were performed on the collected data to identify risk factors for recurrence of CBDS after ERCP. A total of 262 patients were included in the study, of which 51 had recurrence of CBDS, with a recurrence rate of 19.46%. Multivariate Logistic analysis (Table 2 ) showed greasy diet ( P = .436), history of cholecystectomy ( P = .639) and gallstone size ( P = .809) were not independent risk factor for recurrence of stones after ERCP in CBDS. But age ≥65 ( P = .013), history of common bile duct incision ( P = .001), periampullary diverticulum ( P = .001), common bile duct diameter ≥1.5 cm ( P = .024), ERCP ≥2 ( P = .003), the number of stones ≥2 ( P = .015), the common bile duct angle ≤120° ( P = .002) and the placement of bile duct stent ( P = .004) are important independent risk factor for recurrence of stones after ERCP in CBDS. This study confirmed that ag ≥65, history of choledochotomy, periampullary diverticulum, diameter of common bile duct (≥15 mm), multiple ERCP, the number of stones ≥2, stent placement and angle of common bile duct < 120° were independent risk factors for recurrence of CBDS after ERCP.

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“…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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Endoscopic retrograde cholangiopancreatography in patients with surgically altered anatomy

Cited by 30 publications

References 30 publications

Challenges of endoscopic retrograde cholangiopancreatography in patients with Billroth II gastrointestinal anatomy: A review article

Challenges of endoscopic retrograde cholangiopancreatography in patients with Billroth II gastrointestinal anatomy: A review article

Risk factors of stone recurrence after endoscopic retrograde cholangiopancreatography for common bile duct stones

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

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