Using balloon-overtube-assisted enteroscopy for postoperative endoscopic retrograde cholangiopancreatography

Abstract

Endoscopic retrograde cholangiopancreatography (ERCP) is technically more challenging in patients with postsurgical anatomy such as Roux-en-Y anastomosis, frequently mandating an operative intervention. Although limited, there is growing evidence that ERCP can be performed using the balloon-overtube-assisted enteroscopy (BOAE) in patients with complex postoperative anatomy. We present the technical aspects of performing ERCP with the BOAE in patients presenting with complex postsurgical anatomy having biliary problems. ERCP using the BOAE is feasible in patients with complex postsurgical anatomy, permitting diagnostic and therapeutic interventions in 80% of patients.

Multicentric recurrence of intraductal papillary neoplasms of bile duct in the remnant intrahepatic bile duct after curative resection

“…Hence, periodical CT imaging may be insufficient in the present case. Recent technical advances in endoscopic interventions enable diagnostic and therapeutic ERC even in patients with altered gastrointestinal anatomies due to surgery [10] . Therefore in such cases, the use of DBE-assisted direct cholangiography should be considered at the early postoperative phase.…”

Balloon Enteroscopy

“…In addition, the working channel is larger, allowing for an easier introduction of the diagnostic and therapeutic accessories. Although we have performed several cases of DB-ERCP utilizing only the balloon of the overtube ("single-balloon ERCP"), we still recommend attaching the balloons to both the scope and the overtube and we use the double-balloon push-and-pull technique to advance through the small bowel [ 30 ].…”

“…7.4 ) [ 30 ]. These therapeutic scopes have better maneuverability than the smaller diameter enteroscopes.…”

Endoscopic Pancreato-Biliary Interventions

“…Overtube-assisted ERCP is technically challenging, with an unacceptable clinical success rate. 68 Laparoscopyassisted ERCP is frequently performed, but is considered invasive. Access to the gastric remnant via the pouch using EUS-guided transluminal stent placement has been described, as is an alternative to laparoscopy-assisted techniques.…”