Background: Endoscopic retrograde cholangiopancreatography (ERCP) is technically challenging or impossible in patients with complex postsurgical anatomy. The aim of this cohort study was to assess the technical success of ERCP with the single balloon enteroscope (SBE) in patients with Roux-en-Y anastomosis. Patients: Patients with Roux-en-Y anastomosis presenting with cholestasis undergoing ERCP with the SBE technique in a tertiary university hospital. Diagnostic success was defined as successful duct cannulation or securing the diagnosis and therapeutic success was defined as the ability to successfully accomplish endoscopic therapy. Results: ERCP using the SBE was performed on 17 occasions in 13 patients (5 F, 8 M, mean age 66.5 years, range 25–77) with Roux-en-Y anastomosis. Indications for ERCP were biliary obstruction with common bile duct stones and/or cholangitis in all patients. The diagnostic success was 61.5% and the therapeutic success was 53.8%. Therapeutic interventions included dilation of common bile duct stenosis with a balloon (n = 4), biliary stent insertion (n = 2), removal of bile duct stones (n = 2), stent retrieval (n = 2), papillectomy (n = 1), and sphincterotomy (n = 1). No major complications occurred. Conclusions: ERCP using the SBE is feasible in patients with altered postsurgical anatomy presenting with biliary problems permitting diagnostic and therapeutic interventions.

Journal Section:
Original Paper
Keywords:
Single balloon enteroscopy, Endoscopic retrograde cholangiopancreatography, ERCP, Hepaticojejunostomy, Roux-en-Y anastomosis, Cholestasis
1.
Yamamoto H, Kita H, Sunada K, et al: Clinical outcomes of double-balloon endoscopy for the diagnosis and treatment of small-intestinal diseases. Clin Gastroenterol Hepatol 2004;2:1010–1016.
[PubMed]
https://doi.org/10.1016%2FS1542-3565%2804%2900453-7
2.
Fry LC, Neumann H, Kuester D, et al: Small bowel polyps and tumours: endoscopic detection and treatment by double-balloon enteroscopy. Aliment Pharmacol Ther 2008;29:135–142.
https://doi.org/10.1111%2Fj.1365-2036.2008.03864.x
3.
Zhong J, Ma T, Zhang C, et al: A retrospective study of the application of double-balloon enteroscopy in 378 patients with suspected small-bowel diseases. Endoscopy 2007;39:208–215.
[PubMed]
https://doi.org/10.1055%2Fs-2007-966190
4.
Mönkemüller K, Weigt J, Treiber G, et al: Diagnostic and therapeutic impact of double-balloon enteroscopy. Endoscopy 2006;38:67–72.
[PubMed]
https://doi.org/10.1055%2Fs-2005-921190
5.
Emmett DS, Mallat DB: Double-balloon ERCP in patients who have undergone Roux-en-Y surgery: a case series. Gastrointest Endosc 2007;66:1038–1041.
[PubMed]
https://doi.org/10.1016%2Fj.gie.2007.06.056
6.
Chu YC, Yang CC, Yeh YH, Chen CH, Yueh SK: Double-balloon enteroscopy application in biliary tract disease – its therapeutic and diagnostic functions. Gastrointest Endosc 2008;68:585–591.
[PubMed]
https://doi.org/10.1016%2Fj.gie.2008.03.1083
7.
Koornstra JJ: Double balloon enteroscopy for endoscopic retrograde cholangiopancreaticography after Roux-en-Y reconstruction: case series and review of the literature. Neth J Med 2008;66:275–279.
[PubMed]
8.
Mönkemüller K, Fry LC, Bellutti M, et al: ERCP with the double balloon enteroscope in patients with Roux-en-Y anastomosis. Surg Endosc 2008; DOI 10.1007/s10620–008–0538–x (Epub ahead of print).
9.
May A, Nachbar L, Ell C: Push-and-pull enteroscopy using a single-balloon technique for difficult colonoscopy. Endoscopy 2006;38:395–398.
[PubMed]
https://doi.org/10.1055%2Fs-2006-925063
10.
Kawamura T, Yasuda K, Tanaka K, et al: Clinical evaluation of a newly developed single-balloon enteroscope. Gastrointest Endosc 2008;68:1112–1116.
[PubMed]
https://doi.org/10.1016%2Fj.gie.2008.03.1063
11.
Tsujikawa T, Saitoh Y, Andoh A, et al: Novel single-balloon enteroscopy for diagnosis and treatment of the small intestine: preliminary experiences. Endoscopy 2008;40:11–15.
[PubMed]
https://doi.org/10.1055%2Fs-2007-966976
12.
Dellon ES, Kohn GP, Morgan DR, et al: Endoscopic retrograde cholangiopancreatography with single-balloon enteroscopy is feasible in patients with a prior Roux-en-Y anastomosis. Dig Dis Sci 2008; DOI 10.1007/s00464–008–0239–8 (Epub ahead of print).
13.
Mönkemüller K, Fry LC, Bellutti M, et al: ERCP using single-balloon instead of double-balloon enteroscopy in patients with Roux-en-Y anastomosis. Endoscopy 2008;40:19–20.
[PubMed]
https://doi.org/10.1055%2Fs-2007-966949
14.
Cotton PB, Lehman G, Vennes J, et al: Endoscopic sphincterotomy complications and their management: an attempt at consensus. Gastrointest Endosc 1991;37:383–393.
[PubMed]
https://doi.org/10.1016%2FS0016-5107%2891%2970740-2
15.
Mensink PB, Haringsma J, Kucharzik T, Cellier C, Pérez-Cuadrado E, Mönkemüller K, et al: Complications of double balloon enteroscopy: a multicenter study. Endoscopy 2007;39:613–615.
[PubMed]
https://doi.org/10.1055%2Fs-2007-966444
16.
Aabakken L, Bretthauer M, Line PD: Double-balloon enteroscopy for endoscopic retrograde cholangiography in patients with a Roux-en-Y anastomosis. Endoscopy 2007;39:1068–1071.
[PubMed]
https://doi.org/10.1055%2Fs-2007-966841
17.
Matsushita M, Shimantani M, Takaoka M, Okazaki K: ‘Short’ double balloon enteroscope for ERCP with conventional accessories in patients with altered gastrointestinal anatomy. Gastrointest Endosc 2009;69:981–982.
[PubMed]
https://doi.org/10.1016%2Fj.gie.2008.08.001
18.
Chahal P, Baron TH, Topazian MD, Petersen BT, Levy MJ, Gostout CJ: Endoscopic retrograde cholangiopancreatography in post-Whipple patients. Endoscopy 2006;38:1241–1245.
[PubMed]
https://doi.org/10.1055%2Fs-2006-945003
19.
Wright BE, Cass OW, Freeman ML: ERCP in patients with long-limb Roux-en-Y gastrojejunostomy and intact papilla. Gastrointest Endosc 2002;56:225–232.
[PubMed]
https://doi.org/10.1016%2FS0016-5107%2802%2970182-X
© 2009 S. Karger AG, Basel
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