EUS-guided rendezvous with single-balloon enteroscopy for treatment of stenotic pancreaticojejunal anastomosis in post-Whipple patients (with video)

Itoi, Takao; Kikuyama, Masataka; Ishii, Kentaro; Matsumura, Kazuyoshi; Itokawa, Fumihide

doi:10.1016/j.gie.2010.07.010

Cited by 31 publications

(21 citation statements)

References 16 publications

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“…In a Whipple patient, in particular, the approach to a pancreatojejunostomy stricture site using BAE is most challenging because it is mostly invisible, and selective pancreatic duct cannulation by using forward viewing BAE is extremely difficult. In such cases, EUS‐guided pancreatic rendezvous combined with BAE and EUS‐guided pancreatic stenting seems suitable.…”

Section: Discussionmentioning

confidence: 99%

Single‐ and double‐balloon enteroscopy‐assisted endoscopic retrograde cholangiopancreatography in patients with Roux‐en‐Y plus hepaticojejunostomy anastomosis and Whipple resection

Itokawa

Itoi

Ishii

et al. 2014

Digestive Endoscopy

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Background and Aim:In patients with Roux-en-Y hepaticojejunostomy (HJ with R-Y) and Whipple resection, endoscopic retrograde cholangiopancreatography (ERCP) can be challenging. We report our experience with ERCP using balloon-assisted enteroscopy (BAE) (BAE-ERCP) in patients with HJ with R-Y, and Whipple resection.Methods: BAE-ERCP procedures were carried out in 62 patients (HJ with R-Y : Whipple resection = 34:28).Results: Overall, the rates of reaching the anastomosis were 85.3% (29/34) in HJ with R-Y and 96.4% (27/28) in Whipple resection. In terms of HJ with R-Y, insertion success rate by standard single-balloon enteroscopy (SBE) was 89.3% (25/28). Insertion success rate by short BAE, including SBE and double-balloon enteroscopy (DBE), was 50% (3/6). There was a statistically significant difference of insertion success rate between standard long BE and short BE (P = 0.021). However, in the Whipple patients, insertion success rate by standard and short SBE was 93.8% (15/16) and 91.7% (11/12), respectively. Initial insertion success rate by short BAE in Whipple patients was significantly higher than in HJ with R-Y (91.7% vs 50%, P = 0.045). Therapeutic interventions included dilation of anastomosis stricture, stone extraction, endoscopic mechanical lithotripsy, biliary stent placement, stent extraction, endoscopic nasobiliary drainage, direct cholangioscopy, and electrohydraulic lithotripsy. Our HJ with R-Y series and Whipple series treatment success rate was 90% (18/20) and 95.0% (19/20), respectively.Conclusions: BAE-ERCP enabled ERCP to be carried out in patients with HJ. It is considered safe and feasible. Further experience and device improvement are needed.

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Section: Discussionmentioning

confidence: 99%

Single‐ and double‐balloon enteroscopy‐assisted endoscopic retrograde cholangiopancreatography in patients with Roux‐en‐Y plus hepaticojejunostomy anastomosis and Whipple resection

Itokawa

Itoi

Ishii

et al. 2014

Digestive Endoscopy

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“…Patients with surgically altered gastrointestinal anatomy may require double‐balloon enteroscopy for access and localization of difficult‐to‐locate obscure anastomotic sites, particularly in patients with pancreatoenteric anastomosis. Furthermore, endoscopic ultrasound guidance may also be needed . Developing distinct treatment protocols for various strictures is warranted.…”

Section: Discussionmentioning

confidence: 99%

Soehendra stent retriever for dilation of tight biliary and pancreatic duct strictures defying conventional wire‐guided endoscopic techniques: Single‐center experiences

Chen

Ting

et al. 2019

Adv in Digestive Medicine

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Endoscopists frequently encounter severe tight strictures during therapeutic endoscopic retrograde cholangiopancreatography. Dilation using a Soehendra stent retriever (SSR) can be the approach of choice. However, reports of SSR use for the aforementioned strictures are scant. Patients presenting with strictures of the biliary or pancreatic ducts between July 2015 and March 2019 were prospectively screened. The aforementioned strictures allowed the passage of only a guidewire but denied 5.5‐French (Fr) catheter advancement and conventional balloon or catheter dilation. After guidewire passage and endoscopic sphincterotomy, an (7‐Fr) SSR was screwed clockwise over a guidewire and advanced progressively to traverse and dilate the stricture proximally. A plastic stent was then placed in the biliary or pancreatic duct for internal drainage. The stricture and procedural characteristics and immediate postprocedural status were analyzed. Eleven patients (nine men and two women; median age 58 [range 43‐75] years) with severe benign strictures of the biliary (n = 5) or pancreatic (n = 6) ducts were included. The median length of the strictures was 5 (range 2‐9) mm. All 11 severe strictures were successfully dilated using an SSR followed by stenting with a plastic stent (range 5‐7 Fr). Only one patient had brief minor hemobilia immediately after the procedure, and another briefly experienced acute cholangitis. Five (5/6, 83.3%) patients in the pancreatic group eventually achieved stent removal. None of the patients achieved stent removal in the biliary duct group until the end of follow‐up. Nonetheless, the patients did not require percutaneous or surgical interventions. Dilation using the SSR is safe, tolerable, and successful for the tight biliary and pancreatic duct strictures that defy conventional wire‐guided endoscopic access.

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“…Similarly, Kikuyama et al [22] were able to perform endoscopic therapy 2 of 8 patients (25 %) with pancreatojejunostomy stricture after PD. These dismal experiences have resulted in EUS-guided rendezvous treatment of pancreatic issues in PD, but the results of such endoscopic therapies have not been uniformly impressive either [21,22,24]. In our study, we performed 19 ERCP procedures in 10 patients for pancreatic indications.…”

Section: Double-balloon Enteroscope 22mentioning

confidence: 98%

Endoscopic Retrograde Cholangiopancreatography in Patients with Previous Pancreaticoduodenectomy: A Single-Center Experience

et al. 2015

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EUS-guided rendezvous with single-balloon enteroscopy for treatment of stenotic pancreaticojejunal anastomosis in post-Whipple patients (with video)

Cited by 31 publications

References 16 publications

Single‐ and double‐balloon enteroscopy‐assisted endoscopic retrograde cholangiopancreatography in patients with Roux‐en‐Y plus hepaticojejunostomy anastomosis and Whipple resection

Single‐ and double‐balloon enteroscopy‐assisted endoscopic retrograde cholangiopancreatography in patients with Roux‐en‐Y plus hepaticojejunostomy anastomosis and Whipple resection

Soehendra stent retriever for dilation of tight biliary and pancreatic duct strictures defying conventional wire‐guided endoscopic techniques: Single‐center experiences

Endoscopic Retrograde Cholangiopancreatography in Patients with Previous Pancreaticoduodenectomy: A Single-Center Experience

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