Predictors of success for double balloon‐assisted endoscopic retrograde cholangiopancreatography in patients with Roux‐en‐Y anastomosis

Aim To analyze factors involved in procedural failure and to discuss responses to procedural failure by using the outcomes of endoscopic retrograde cholangiopancreatography (ERCP) carried out using a short‐type single‐balloon enteroscope (short SBE) in patients with surgically altered gastrointestinal anatomy. Methods The study sample included patients who underwent ERCP‐related procedures using a short SBE between September 2011 and September 2018 at our hospital. Outcomes, including procedural success rate, were studied retrospectively to analyze the factors involved in procedural failure. Results Analysis included 191 procedures carried out in 121 patients. Procedural success rate was 85.9% with an adverse event rate of 8.4%. Causes of procedural failure included malignant biliary obstruction (odds ratio [OR] 2.89, 95% confidence interval [CI] 1.19–7.25, P = 0.02), first ERCP attempt (OR: 5.32, 95% CI: 1.30–36.30, P = 0.02), and Roux‐en‐Y reconstruction (OR: 0.08, 95% CI: 0.004–0.39, P < 0.001). With regard to the response to failure, in cases of malignant biliary obstruction, reattempted short SBE‐assisted ERCP was difficult because of invasion of the small intestine or papilla. A large number of these cases required alternative treatment (10 of 15 cases, 66.7%) using percutaneous transhepatic biliary drainage (PTBD) or endoscopic ultrasound‐guided biliary drainage (EUS‐BD). Conclusion Endoscopic retrograde cholangiopancreatography using a short SBE is safe and effective, with malignant biliary obstruction being a specific cause of failure. Technical proficiency with different modalities, such as PTBD and EUS‐BD, is necessary to respond to failure in these cases.

Section: Discussionmentioning

confidence: 99%

Analysis of the factors involved in procedural failure: Endoscopic retrograde cholangiopancreatography using a short‐type single‐balloon enteroscope for patients with surgically altered gastrointestinal anatomy

Tanisaka

Ryozawa

Mizuide

et al. 2019

“…Endoscopic retrograde cholangiopancreatography (ERCP) for patients with surgically altered gastrointestinal anatomy remains challenging. Recently, short‐type double‐balloon endoscopes (DBE) for pancreaticobiliary interventions in patients with surgically altered anatomy have become available in many institutions . Success rates of reaching the target site and of ERCP‐related interventions associated with use of these endoscopes are reported to range between 73% and 100% and between 85% and 100%, respectively .…”

Section: Introductionmentioning

confidence: 99%

“…Recently, short‐type double‐balloon endoscopes (DBE) for pancreaticobiliary interventions in patients with surgically altered anatomy have become available in many institutions . Success rates of reaching the target site and of ERCP‐related interventions associated with use of these endoscopes are reported to range between 73% and 100% and between 85% and 100%, respectively . However, in a multicenter study, we previously showed that ERCP using a conventional short‐type DBE (EI‐530B; Fujifilm, Tokyo, Japan) is a lengthy procedure, requiring approximately 22 ± 20 min to reach the target site and 56 ± 33 min to complete ERCP‐related interventions .…”

Section: Introductionmentioning

confidence: 99%

Performance of a new short‐type double‐balloon endoscope with advanced force transmission and adaptive bending for pancreaticobiliary intervention in patients with surgically altered anatomy: A propensity‐matched analysis

Yamada

Kogure

Nakai

et al. 2018

“…[4][5][6] Percutaneous transhepatic biliary drainage (PTBD) is the conventionally alternative method in patients who fail ERCP. In cases of failed cannulation in surgically altered anatomies, balloon enteroscopy-assisted ERCP is as an alternative that has shown high technical and clinical success in specialized centers; [10][11][12] however, currently, it is not a well-established procedure. [7][8][9] It may also be difficult to carry out when the intrahepatic bile ducts are not dilated.…”

Section: Introductionmentioning

confidence: 99%

Recent advances in endoscopic ultrasound‐guided biliary drainage

Minaga

Kitano

2017

Endoscopic ultrasound-guided biliary drainage (EUS-BD) is increasingly used as an alternative in patients with biliary obstruction who fail standard endoscopic retrograde cholangiopancreatography (ERCP). The two major endoscopic approach routes for EUS-BD are the transgastric intrahepatic and the transduodenal extrahepatic approaches. Biliary drainage can be achieved by three different methods, transluminal biliary stenting, transpapillary rendezvous technique, and antegrade biliary stenting. Choice of approach route and drainage method depends on individual anatomy, underlying disease, and location of the biliary stricture. Recent meta-analyses have revealed that cumulative technical success and adverse event rates were 90-94% and 16-23%, respectively. Development of new dedicated devices for EUS-BD would help refine the technical aspects and minimize the possibility of complications, making it a more promising procedure.