ERCP with the double balloon enteroscope in patients with Roux-en-Y anastomosis

Klaus Mönkemüller, Lucia C Fry, Michael Bellutti, Helmut Neumann, Peter Malfertheiner
Surgical Endoscopy 2009, 23 (9): 1961-7

BACKGROUND: Endoscopic retrograde cholangiopancreatography (ERCP) is technically more challenging in patients with postsurgical anatomy. We assessed the technical success of performing ERCP with the double balloon enteroscope (DBE) in patients with Roux-en-Y anastomosis.

METHODS: This is a prospective evaluation of patients with Roux-en-Y anastomosis who underwent ERCP with the DBE. Diagnostic success was defined as successful duct cannulation or securing the diagnosis, and therapeutic success was defined as the ability to treat the underlying disorder. Complications of ERCP were defined according to standard criteria.

RESULTS: ERCP using the DBE was performed on 17 occasions in 11 patients (10 men; mean age, 59.7 (range, 36-77) years) with Roux-en-Y anastomosis with or without hepaticojejunostomy. Indications for ERCP: biliary obstruction or cholestasis (n = 11). The overall diagnostic success was 82%, and the therapeutic success was 58%. Reasons for failed biliary cannulation included: inability to reach the proximal end of the afferent loop (n = 1), impossibility to advance the wire into the CDB despite adequate insertion of the biliary catheter into the distal CBD (n = 2), and inability to advance the stent over an adequately placed guidewire (n = 1). One major complication occurred (5.8%): perforation of the hepaticojejunostomy in a patient with recurrent choledocolithiasis, which was successfully resolved surgically.

CONCLUSIONS: ERCP using the DBE is feasible in patients with complex postsurgical anatomy, permitting diagnostic and therapeutic interventions in 82% and 58% of cases, respectively. Nevertheless, due to the complex anatomy, presence of adhesions, and looping of the usually long limbs complications can occur.

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