Utility of the Short Double-Balloon Enteroscope to Perform Pancreaticobiliary Interventions in Patients with Surgically Altered Anatomy in a US Multicenter Study

Siddiqui, Ali A.; Chaaya, Adib; Shelton, Corbett; Marmion, Jennifer; Kowalski, Thomas E.; Loren, David E.; Heller, Stephen; Haluszka, Oleh; Adler, Douglas G.; Tokar, Jeffrey L.

doi:10.1007/s10620-012-2385-z

Cited by 83 publications

(113 citation statements)

References 21 publications

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“…The success rates obtained in the present study are similar to those described for the conventional method, for per-oral route; being superior to those obtained with the use of frontal vision devices [18,[19][20][21][22][23][24][25][26][27][28][29][30][31].…”

Section: Discussionsupporting

confidence: 83%

“…In this context, success rates of papillary or bile anastomosis range 55.0-100.0% in the series described in the literature, with catheterization rates, after reaching, above 90.0% [18][19][20][21][22][23][24][25][26][27][28][29][30][31], no identified significant difference between methods [28]. The high success rates of both papillary reach and bile duct catheterization should be attributed to the fact that most of the patients reported were not carriers of Roux-en-Y made with the purpose of weight loss, thus presenting segments of intestinal loops that make up the Y shorter, when compared to patients after bariatric surgery.…”

Section: Discussionmentioning

confidence: 99%

“…The high success rates of both papillary reach and bile duct catheterization should be attributed to the fact that most of the patients reported were not carriers of Roux-en-Y made with the purpose of weight loss, thus presenting segments of intestinal loops that make up the Y shorter, when compared to patients after bariatric surgery. Another determining factor in obtaining high success rates of papilla catheterization was the presence of digestive bile anastomoses instead of the native papilla in most patients [18][19][20][21][22][23][24][25][26][27][28][29][30][31]. Increased complication rates in these procedures, including perforation and pancreatitis, have also been reported [15,20,26,30,32,33].…”

Section: Discussionmentioning

confidence: 99%

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Approach of the Bile Duct by Gastrostomy in Patients With Bypass in Roux-en-Y Proved to Be Safe and Effective

et al. 2017

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Background: The prevalence and increase of obesity in the world are that 2.3 billion adults were overweight and 700 million adults were obese in 2015. In the context of the morbid obesity pandemic, bariatric surgery was presented as a gold standard treatment. It is known that the prevalence of cholelithiasis is 3 to 4 times higher in morbidly obese patients when compared to the general population. Literature reports that the first attempts to approach the biliary tract in patients with gastric bypass in Roux-en-Y, were performed transorally and had resulted in low success rates. The aim of this study was to analyze the results of the use of the endoscopic transgastrostomy technique for the treatment of biliary tract diseases in patients submitted to Yde-Roux bypass.

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Section: Discussionsupporting

confidence: 83%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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Approach of the Bile Duct by Gastrostomy in Patients With Bypass in Roux-en-Y Proved to Be Safe and Effective

et al. 2017

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“…The short DBE with a working length of 152 cm allows the use of standard ERCP accessories and thus may prove to be extremely useful. 8,9 However, there are no studies comparing short and long DBE ERCP.…”

Section: Enteroscopy Assisted Ercpmentioning

confidence: 99%

Endoscopic retrograde cholangiopancreatography in surgically altered anatomy

Goyal

Kasapoğlu

Thosani

2017

Int J Gastrointest Interv

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Endoscopic retrograde cholangiopancreatography (ERCP) in a surgically altered anatomy is a technically challenging undertaking with variable success and adverse event rates. There are several potential challenges to successfully perform an ERCP in patients with surgically altered anatomy such as identification of afferent limb, accessing and visualization of the papilla, and selective cannulation of the biliary and pancreatic ducts from altered orientation of the papilla. Several strategies to improve the success rate have been recommended by various endoscopy experts. In this review, we discussed the published literature involving various ERCP techniques described for surgically altered anatomies.

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“…A multicenter study by Siddiqui et al performed ERCPs in 39 RYGB patients using the 'short' double balloon enteroscope (EC-450BI5; Fujinon), achieving successful bile duct cannulation in 29 of the 32 patients in whom the papilla/surgical anastomoses was reached.A full spectrum of therapeutic maneuvers was performed, including sphincterotomy, stone extraction, balloon dilation, and the insertion of plastic/metal stents [20][21][22][23][24][25].Additionally, studies have been done by Moreels et al [22] and Patel et al [26] demonstrating the feasibility of diagnostic and therapeutic DBE-ERCP in large cohorts of patients who had undergone a variety of of Roux-en-Y reconstructive surgeries.These studies along with others are summarized in Table 2.…”

Section: Dbe-ercpmentioning

confidence: 99%

The Role of Overtube-assisted Deep Enteroscopy ERCP in Roux-en-Y Gastric Bypass Patients

Ali¹,

Ahmed²,

Iqbal³

2014

J Obes Weight Loss Ther

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Bariatric surgery is the fastest growing medical intervention for obesity performed in theUS and Roux-en-Y Gastric Bypass (RYGB), is considered the "gold standard"comprising more than 60% of these cases. However, patients with surgically alteredanatomy after undergoing RYGB pose serious challenges to the endoscopist whenaccess to the biliary or pancreatic systems is required. Hurdles include reaching themajor papilla after navigating the length of the roux limb (often >100 cm) given thelimitations of standard gastroscopes and even push enteroscopes in achievingsufficient depth of insertion, orientation (upside-down configuration of the papilla), andthe lack of accessories that are actually designed for the long endoscopes required forperforming ERCPs in this patient population.To work around the aforementioned problems-specifically the length of the Rouxlimb-innovative techniques, notably overtube systems have been developed to allowthe enteroscope to reach the ampulla and perform ERCP. Three overtube-systems arepresently available: Double-balloon Enteroscopy (DBE), Single-balloon Enteroscopy(SBE), and Spiral Enteroscopy (SE). This review is designed to describe the role of these 3overtube systems in assisting with ERCP in RYGB patients based on existing literatureand evaluate their success rates in reaching the ampulla, diagnostic & therapeuticyields, and complication rates.Our review shows good success rates when comparing ability to reach ampulla (DBEERCP:83%; SBE-ERCP: 71%; SE-ERCP: 70%), diagnostic (DBE-ERCP: 77%; SBEERCP:55%; SE-ERCP: 41%) and therapeutic yields (DBE-ERCP: 75%; SBE-ERCP:81%; SE-ERCP: 68%) with low complication rates for all three systems.The sheer volume of RYGB procedures being performed and the associated predictedincrease in complications will lead to advanced endoscopists encountering morepatients with surgically altered anatomy and our review provides evidence thatovertube-assisted systems are effective and safe, and should be considered as a firstline modality in RYGB patients requiring ERCP.

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Utility of the Short Double-Balloon Enteroscope to Perform Pancreaticobiliary Interventions in Patients with Surgically Altered Anatomy in a US Multicenter Study

Abstract: The current study demonstrates that DBE assisted ERCP for pancreaticobiliary interventions using a short enteroscope are feasible in patients with surgically altered anatomy.

Cited by 83 publications

References 21 publications

Approach of the Bile Duct by Gastrostomy in Patients With Bypass in Roux-en-Y Proved to Be Safe and Effective

Approach of the Bile Duct by Gastrostomy in Patients With Bypass in Roux-en-Y Proved to Be Safe and Effective

Endoscopic retrograde cholangiopancreatography in surgically altered anatomy

The Role of Overtube-assisted Deep Enteroscopy ERCP in Roux-en-Y Gastric Bypass Patients

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