Evaluation of complications after endoscopic retrograde cholangiopancreatography using a short type double balloon endoscope in patients with altered gastrointestinal anatomy: a single‐center retrospective study of 1,576 procedures

Abstract

Background and AimEndoscopic retrograde cholangiopancreatography (ERCP) using balloon‐assisted endoscope such as double‐balloon endoscope is even effective for patients with surgically altered anatomy. Yet comprehensive studies on complications of ERCP using balloon‐assisted endoscope have not been made. We analyzed the characteristics and the causes of complications of ERCP using double‐balloon endoscope (DB‐ERCP) procedures and aimed to suggest effective managements.MethodsA total of 1576 procedures of DB‐ERCP in 714 patients with surgically altered gastrointestinal anatomy in our hospital were evaluated retrospectively using a statistic analysis.ResultsThe overall complication occurrence rate was 5.8%. By type of complications are perforation 3.2%, mucosal laceration 0.5%, hemorrhage 1.0%, pancreatitis 0.6%, respiratory disorder 0.4%, and others 0.2%. By type of surgical reconstruction methods were Roux‐en‐Y reconstruction with choledocho‐jejunal anastomosis 4.2%, Roux‐en‐Y reconstruction without choledocho‐jejunal anastomosis 6.7%, pancreaticoduodenectomy 4.5%, pylorus preserving pancreaticoduodenectomy 4.2%, Billroth II gastrectomy (B‐II) 11.6%, and other reconstruction method (others) 7.4%. The contributing factors calculated by a multivariate analysis were B‐II (odds ratio: 1.864, 95% confidence interval: 1.001–3.471, P = 0.050) and the presence of naïve papilla (odds ratio: 3.268, 95% confidence interval: 1.426–7.490, P = 0.005).ConclusionsDB‐ERCP is a safe method with a total complication rate of 5.8% that could be considered within an acceptable range. The most common complication was the injury of the digestive tract such as perforation. Affecting risk factors for complications were B‐II and the presence of naïve papilla. DB‐ERCP procedures should be performed carefully of these factors.

Balloon Enteroscopy-Assisted Endoscopic Retrograde Cholangiopancreatography for the Treatment of Common Bile Duct Stones in Patients with Roux-en-Y Gastrectomy: Outcomes and Factors Affecting Complete Stone Extraction

“…Adverse events occur in 5–18% of patients treated with this procedure [ 15 , 20 , 22 , 44 ], and the incidence rate was 5% in the present study. In contrast to conventional ERCP, perforation is one of the most common adverse events for this procedure [ 45 ] and occurs mainly during scope insertion or stone extraction. Immediately noticing the issue and thoroughly performing intraluminal drainage is important, as the situation can sometimes be managed if minor perforation occurs, as shown in one of our cases.…”

Risk factors for adverse events associated with endoscopic retrograde cholangiopancreatography in patients with surgically altered anatomy: a retrospective study

“…In our present study, ERCP-related adverse events occurred in 25.6% of patients. Previous studies reported the complication rate from 3.5 to 12.4% [ 9 , 11 , 12 , 16 , 18 , 38 – 40 ]. However, hyperamylasemia was not included in most of these studies.…”

Recent Advances of Interventional Endoscopic Retrograde Cholangiopancreatography and Endoscopic Ultrasound for Patients with Surgically Altered Anatomy

“…One case of intestinal perforation requiring surgery was included in the report. A single-center large cohort study reported that Billroth II gastrectomy (B-II) and the native papilla were notable risk factors for complications [40]. In that report, especially cases of B-II with an extremely short afferent loop between the gastro-jejunal anastomosis and Treitz ligament, had a risk of perforation because B-II with an extremely short afferent loop tend to receive a strong force while proceeding a scope into the afferent loop.…”