The use of the double-balloon enteroscope for endoscopic retrograde cholangiopancreatography and biliary stent placement after Roux-en-Y hepaticojejunostomy

Moreels, Tom G.; Roth, Bernard; Vandervliet, E.; Parizel, Paul M.; Dutré, Joris; Pelckmans, Paul

doi:10.1055/s-2007-966410

Cited by 38 publications

(30 citation statements)

References 2 publications

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“…It was initially designed for deep and even complete intubation of the small bowel. However, double-balloon endoscopy has shown to be useful not only for enteroscopy, but also for difficult colonoscopy, and case series illustrated successful ERCP after Roux-en-Y reconstructive surgery of the small bowel [7,8,9,10,11,12,16]. Since obesity has become an endemic pathology both in the USA and in Europe, bariatric surgery is increasingly performed as a treatment of morbid obesity and its complications [17,18,19].…”

Section: Discussionmentioning

confidence: 99%

“…Pathology within the excluded segments may necessitate surgery [21]. However, preliminary data from case reports suggest that interventional double-balloon enteroscopy may prevent redo surgery [7,8,9,10,11,12]. …”

Section: Discussionmentioning

confidence: 99%

“…We and others previously showed that endoscopic retrograde cholangiopancreatography (ERCP) after Roux-en-Y reconstruction is feasible with the double-balloon enteroscope [7,8,9,10,11,12]. In addition, the excluded stomach after bariatric gastric bypass surgery can now be accessed endoscopically [13,14].…”

Section: Introductionmentioning

confidence: 99%

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Diagnostic and Therapeutic Double-Balloon Enteroscopy after Small Bowel Roux-en-Y Reconstructive Surgery

Moreels¹,

Hubens²,

Ysebaert

et al. 2009

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Background: Roux-en-Y reconstruction excludes the afferent limb and the biliopancreatic system from conventional endoscopic access. Postoperative problems in these excluded gastrointestinal systems are therefore often dealt with surgically. We investigated the usefulness of the therapeutic double-balloon enteroscope to perform interventional endoscopic procedures in the excluded segment of the gastrointestinal tract after Roux-en-Y reconstruction. Methods: 30 procedures were performed in 22 patients with Roux-en-Y reconstruction after enterobiliary anastomosis, gastrectomy or bariatric gastric bypass. All procedures were performed with the therapeutic double-balloon enteroscope, under general anesthesia and with fluoroscopic control. Results: ERCP at the enterobiliary anastomosis was successful in 90% (n = 10) of the procedures. ERCP at the intact papilla was successful in 60% (n = 5). Enterocutaneous fistula closure after (sub)total gastrectomy was performed in 2 procedures. Successful diagnostic procedures encompassed intubation of the excluded stomach after bariatric gastric bypass (89%, n = 9) or the afferent limb after Roux-en-Y reconstruction (75%, n = 4). The overall success rate in accessing the aimed excluded segment with the double-balloon enteroscope was 87%. Interventional procedures were able to avoid surgery in 65%. One retroperitoneal perforation occurred during ERCP which was conservatively treated. Conclusions: Excluded gastrointestinal segments after Roux-en-Y reconstruction can be accessed with a substantial success rate using double-balloon enteroscopy. Therapeutic interventions like ERCP can prevent surgery in the majority of patients.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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Diagnostic and Therapeutic Double-Balloon Enteroscopy after Small Bowel Roux-en-Y Reconstructive Surgery

Moreels¹,

Hubens²,

Ysebaert

et al. 2009

Digestion

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“…Endoscopic biliary access to the Roux loop may be gained by complex methods, [2][3][4] but is usually impossible.…”

Section: Introductionmentioning

confidence: 99%

Obstructive Jaundice after Bilioenteric Anastomosis: Transhepatic and Direct Percutaneous Enteral Stent Insertion for Afferent Loop Occlusion

Laasch

2010

Gut Liver

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Recurrent tumour after radical pancreaticoduodenectomy may cause obstruction of the small bowel loop draining the liver. Roux-loop obstruction presents a particular therapeutic challenge, since the postsurgical anatomy usually prevents endoscopic access. Careful multidisciplinary discussion and multimodality preprocedure imaging are essential to accurately demonstrate the cause and anatomical location of the obstruction. Transhepatic or direct percutaneous stent placement should be possible in most cases, thereby avoiding long-term external biliary drainage. Gastropexy T-fasteners will secure the percutaneous access and reduce the risk of bile leakage. The static bile is invariably contaminated by gut bacteria, and systemic sepsis is to be expected. Enteral stents are preferable to biliary stents, and compound covered stents in a sandwich construction are likely to give the best long-term results. Transhepatic and direct percutaneous enteral stent insertion after jejunopexy is illustrated and the literature reviewed. (Gut Liver 2010; 4(Suppl. 1):S89-95)

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“…Meanwhile, DBE has also provided endoscopic access to biliopancreatic openings that were not reachable previously and ERCP using double balloon enteroscope has been described as case reports [4][5][6] and case series [7][8][9][10][11][12]. These studies show us merely the feasibility of the procedure.…”

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confidence: 99%

Endoscopic retrograde cholangiography by double balloon enteroscopy in patients with Roux-en-Y hepaticojejunostomy

et al. 2009

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The use of the double-balloon enteroscope for endoscopic retrograde cholangiopancreatography and biliary stent placement after Roux-en-Y hepaticojejunostomy

Cited by 38 publications

References 2 publications

Diagnostic and Therapeutic Double-Balloon Enteroscopy after Small Bowel Roux-en-Y Reconstructive Surgery

Diagnostic and Therapeutic Double-Balloon Enteroscopy after Small Bowel Roux-en-Y Reconstructive Surgery

Obstructive Jaundice after Bilioenteric Anastomosis: Transhepatic and Direct Percutaneous Enteral Stent Insertion for Afferent Loop Occlusion

Endoscopic retrograde cholangiography by double balloon enteroscopy in patients with Roux-en-Y hepaticojejunostomy

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