Failure Factors to Reach the Blind End Using a Short-Type Single-Balloon Enteroscope for ERCP with Roux-en-Y Reconstruction: A Multicenter Retrospective Study

Abstract

Background. Failure factors in reaching the blind end (papillae of Vater, bilioenteric anastomosis) during short-type single-balloon enteroscope-assisted endoscopic retrograde cholangiopancreatography (sSBE-assisted ERCP) in patients with Roux-en-Y (R-Y) reconstruction remain to be evaluated. Aims. We investigated the failure factors in such patients. Methods. We retrospectively studied 253 initial sessions of sSBE-assisted ERCP at three endoscopy centers from April 2008 through September 2017, examining failure factors and complications associated with scope insertion in patients with R-Y reconstruction. Results. R-Y reconstruction was performed in 157 patients (with gastrectomy: 122 patients; without gastrectomy plus bilioenteric anastomosis: 35 patients). R-Y without gastrectomy (p=0.001; odds ratio (OR), 5.73; 95% confidence interval (CI), 2.07 to 16.01) and the presence of peritoneal dissemination (p=0.021; OR, 4.71; 95% CI, 1.27 to 17.54) were significant failure factors. Insufficient sSBE length was the cause of failure in 17 (11%) of the 157 patients, and 13 (76%) of the 17 patients were with R-Y without gastrectomy. In cases of insufficient short-type length, using a long-type SBE significantly increased the success rate (p=0.002). Gastrointestinal stenosis was a significant failure factor (p=0.011) in patients with peritoneal dissemination. Perforation occurred in 2 patients who responded to conservative treatment. Conclusions. Failure factors during sSBE-assisted ERCP were R-Y without gastrectomy and the presence of peritoneal dissemination.

Recent advances of endoscopic retrograde cholangiopancreatography using balloon assisted endoscopy for pancreaticobiliary diseases in patients with surgically altered anatomy: Therapeutic strategy and management of difficult cases

“…20 Several other studies have reported the usefulness of DB-ERCP [19][20][21][22][23][24][25][26][27][28][29] and ERCP using short-type SBE (SB-ERCP). [30][31][32][33][34][35][36][37][38][39] These results suggest that the use of short-type BAE has increased the success rate of BAE-ERCP, which is possibly due to its new features that facilitate smooth advancement of scopes, improved ability to reach blind end, and increased line-ups of applicable devices for ERCP-related interventions.…”

“…The first large‐scale multi‐center prospective study of ERCP using a short‐type DBE (DB‐ERCP) was conducted in Japan which reported the success rates of reaching the blind end, of diagnosis and of treatment were 97.7%, 96.4%, and 97.9%, respectively 20 . Several other studies have reported the usefulness of DB‐ERCP 19–29 and ERCP using short‐type SBE (SB‐ERCP) 30–39 . These results suggest that the use of short‐type BAE has increased the success rate of BAE‐ERCP, which is possibly due to its new features that facilitate smooth advancement of scopes, improved ability to reach blind end, and increased line‐ups of applicable devices for ERCP‐related interventions.…”

“…According to a multi‐center retrospective study using SBE, it was suggested that a failure to reach the blind end was associated with patients who had not undergone gastrectomy or had presence of peritoneal dissemination 30 . Peritoneal dissemination is the only condition where BAE‐ERCP should not be indicated, as the presence of malignant gastrointestinal strictures significantly decreases the success rate of reaching the blind end.…”

“…According to a multi-center retrospective study using SBE, it was suggested that a failure to reach the blind end was associated with patients who had not undergone gastrectomy or had presence of peritoneal dissemination. 30 Peritoneal dissemination is the only condition where BAE-ERCP should not be indicated, as the presence of malignant gastrointestinal strictures significantly decreases the success rate of reaching the blind end. Patients with peritoneal dissemination might have a latent gastrointestinal stricture even if preoperative CT images reveals no gastrointestinal stenosis or ileus, hence indication for BAE-ERCP should be carefully examined in these cases.…”

Factors Affecting Technical Difficulty in Balloon Enteroscopy-Assisted Endoscopic Retrograde Cholangiopancreatography in Patients with Surgically Altered Anatomy

“…Thus, we assumed that the procedure was particularly difficult in R-Y reconstruction with partial gastrectomy because the endoscope can bend easily in the gastric remnant, making the endoscope difficult to support; this notion might explain why cannulation becomes difficult. In addition, Kawaguchi et al [ 35 ] analyzed the factors contributing to failure to reach the blind end in patients with intestinal tract reconstruction, and they demonstrated that R-Y without gastrectomy ( p = 0.001; OR, 5.73) is a significant factor for procedure failure. These reports support our results.…”