Single-balloon enteroscopy effectively enables diagnostic and therapeutic retrograde cholangiography in patients with surgically altered anatomy

Wang, Andrew Y.; Sauer, Bryan G.; Behm, Brian W.; Ramanath, Madhuri; Cox, Dawn G.; Ellen, Kristi; Shami, Vanessa M.; Kahaleh, Michel

doi:10.1016/j.gie.2009.10.051

Cited by 123 publications

(54 citation statements)

References 35 publications

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“…Later, single‐balloon enteroscope (SBE) with balloon only at the overtube was shown to be feasible for therapeutic ERCP in complex surgical anatomy. Further modification of SBE was done when a shorter length (152 cm) was introduced which has a working diameter of 3.2 mm and can allow use of conventional ERCP accessories . Recently, another modification of short SBE was passive bending and force transmission features …”

Section: Options After Failed Ercpmentioning

confidence: 99%

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Endoscopic management of acute cholangitis as a result of common bile duct stones

Ramchandani

Pal

Reddy

2017

Digestive Endoscopy

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Acute cholangitis is infectious disease of the biliary system and potentially can cause significant morbidity and mortality. With advances in intensive care, antibiotic therapy advances and endoscopic and other modalities of biliary drainage, mortality rates have significantly come down of late. Although most cases respond to antibiotics alone, definitive therapy is required later in most of the patients. Increased biliary pressure leads to biliovenous reflux of bacteria and purulent bile into the circulation leading to systemic inflammation and sepsis with subsequent organ dysfunction. Biliary decompression increases antibiotic penetration in bile. Therefore, patients with high‐risk factors and organ dysfunction require early and urgent biliary drainage, respectively, as they are unlikely to respond with antibiotics alone. Biliary decompression is best achieved by endoscopic retrograde cholangiopancreatography (ERCP) compared to percutaneous and surgical decompression. ERCP can be technically difficult and sometimes unsuccessful especially in patients with altered anatomy and upper gastrointestinal obstruction. Earlier percutaneous transhepatic biliary drainage (PTBD) and surgery were the only viable options in those patients. PTBD requires a dilated biliary system, is more invasive and cannot achieve ductal clearance in cholangitis as a result of choledocholithiasis, whereas surgery is associated with high morbidity and mortality. Advances in therapeutic endoscopy such as balloon enteroscopy‐guided biliary drainage or endoscopic ultrasound guided‐biliary drainage have added new dimensions to endoscopic management of acute cholangitis as a result of choledocholithiasis obviating the need for more invasive procedures.

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Section: Options After Failed Ercpmentioning

confidence: 99%

“…Wang et al . described 13 case series in which four cases had cholangitis, only one patient had successful therapeutic ERCP, two patients required surgery and one patient did not require intervention …”

Section: Options After Failed Ercpmentioning

confidence: 99%

Endoscopic management of acute cholangitis as a result of common bile duct stones

Ramchandani

Pal

Reddy

2017

Digestive Endoscopy

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“…Roux-en-Y hepaticojejunostomy is performed with various indications, including recurrent biliary stones, benign distal biliary stricture, cholangiocarcinoma, choledochal cyst, and liver transplantation. Post-liver transplantation biliary adverse events occur in up to 20% of patients and are important causes of early and late postoperative morbidity and mortality [4]. The most common biliary adverse events are strictures, leaks, stones, and sphincter of Oddi dysfunction [5].…”

Section: Pancreaticobiliary Complications After Gi Surgerymentioning

confidence: 99%

“…A prototype oblique-viewing endoscope with an elevator has been used to circumvent this drawback [1]. Limited but increasing amount of data are available about overtube-assisted enteroscopy ERCP with a single-balloon enteroscope (SBE) [4,9] or double-balloon enteroscope (DBE) [10] to get technical success in case of failure to reach the anastomotic site with standard endoscopes. Other endoscopic options to access the biliary tree is combined use of interventional radiology and ERCP in which the placement of a stent or guide wire by an interventional radiologist was followed by subsequent endoscopic management.…”

Section: Challenging Postsurgical Altered Gi Anatomy For Endoscopic Tmentioning

confidence: 99%

Challenges of Endoscopic Management of Pancreaticobiliary Complications in Surgically Altered Gastrointestinal Anatomy

Wai

Kim

2016

Clin Endosc

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Pancreaticobiliary complications following various surgical procedures, including liver transplantation, are not uncommon and are important causes of morbidity and mortality. Therapeutic endoscopy plays a substantial role in these patients and can help to avoid the need for reoperation. However, the endoscopic approach in patients with surgically altered gastrointestinal (GI) anatomy is technically challenging because of the difficulty in entering the enteral limb to reach the target orifice to manage pancreaticobiliary complications. Additional procedural complexity is due to the need of special devices and accessories to obtain successful cannulation and absence of an elevator in forward-viewing endoscopes, which is frequently used in this situation. Once bilioenteric anastomosis is reached, the technical success rates achieved in expert hands approach those of patients with intact GI anatomy. The success of endoscopic therapy in patients with surgically altered GI anatomy depends on multiple factors, including the expertise of the endoscopist, understanding of postoperative anatomic changes, and the availability of suitable scopes and accessories for endoscopic management. In this issue of Clinical Endoscopy, the focused review series deals with pancreatobiliary endoscopy in altered GI anatomy such as bilioenteric anastomosis and post-gastrectomy.

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“…The success rate of ERCP using the Billroth II method is lower in patients with choledocholithiasis (63–93%) than in patients with an intact stomach (87–97%) [9]. A single- or a double-balloon endoscope is considered useful for such patients [7,10,11]. However, endoscopic procedures are still difficult to perform; they need to be performed by highly experienced endoscopists and require the use of special equipment [9-12].…”

Section: Introductionmentioning

confidence: 99%

Bile duct stone formation around a nylon suture after gastrectomy: A case report

et al. 2013

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BackgroundMany cases of choledocholiths formed around sutures and clips used during cholecystectomy have been reported. We describe a case of gallstone formation around a nylon suture after non-biliary surgery. To the best of our knowledge, this is the first report of such a case.Case presentationA 75-year-old Japanese man, who had undergone distal gastrectomy for gastric cancer and reconstruction with the Billroth II method 8 years earlier, presented with gastric discomfort. Abdominal ultrasonography was conducted and we diagnosed cholecysto-choledocholithiasis with dilatation of the intrahepatic bile duct. He underwent cholecystectomy and cholangioduodenostomy for choledocholith removal. Gallstones, which had formed around a nylon suture used during the previous gastrectomy, were found in the bile duct. Sutures of the same material had also been placed on the duodenum. Chemical analysis revealed that the stones were composed of calcium bilirubinate. The patient was discharged on postoperative day 19, and choledocholithiasis has not recurred thus far.ConclusionThe findings from this case suggest that standard, non-resorbable sutures used in gastrectomy may be associated with the formation of bile duct stones; therefore, absorbable suture material may be required to avert gallstone formation even in the case of gastrectomy.

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Single-balloon enteroscopy effectively enables diagnostic and therapeutic retrograde cholangiography in patients with surgically altered anatomy

Cited by 123 publications

References 35 publications

Endoscopic management of acute cholangitis as a result of common bile duct stones

Endoscopic management of acute cholangitis as a result of common bile duct stones

Challenges of Endoscopic Management of Pancreaticobiliary Complications in Surgically Altered Gastrointestinal Anatomy

Bile duct stone formation around a nylon suture after gastrectomy: A case report

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