Analysis of the factors of procedural failure: ERCP using a short-type single-balloon enteroscope for patients with surgically altered gastrointestinal anatomy

Yuki Tanisaka, Shomei Ryozawa, Masafumi Mizuide, Maiko Harada, Akashi Fujita, Tomoya Ogawa, Kouichi Nonaka, Tomoaki Tashima, Ryuichiro Araki
Digestive Endoscopy: Official Journal of the Japan Gastroenterological Endoscopy Society 2019 April 3

OBJECTIVES: To analyze factors of procedural failure and to discuss responses to procedural failure, by using the outcomes of endoscopic retrograde cholangiopancreatography (ERCP), performed using a short-type single-balloon enteroscope (short SBE) in patients with surgically altered gastrointestinal anatomy.

METHODS: The study sample included patients who underwent ERCP-related procedures using a short SBE, between September 2011 and September 2018, at our hospital. Outcomes, including the procedural success rate, were studied retrospectively to analyze the factors of procedural failure.

RESULTS: The analysis included 191 procedures performed in 121 patients. The procedural success rate was 85.9%, with a rate of adverse events of 8.4%. Causes of procedural failure included malignant biliary obstruction (odds ratio [OR] 2.89, 95% confidence interval [CI] 1.19-7.25, P=0.02), first time ERCP attempt (OR 5.32, 95%CI 1.30-36.30, P=0.02) and Roux-en-Y reconstruction (OR 0.08, 95%CI 0.004-0.39, P<0.001). With regard to the response to failure, in cases of malignant biliary obstruction, reattempted short SBE-assisted ERCP was difficult due to invasion of the small intestine or papilla. A large number of these cases required alternative treatment (10 of 15 cases, 66.7%), using percutaneous transhepatic biliary drainage (PTBD) or endoscopic ultrasound-guided biliary drainage (EUS-BD).

CONCLUSIONS: ERCP using a short SBE is safe and effective, with malignant biliary obstruction being a specific cause of failure. Technical proficiency with different modalities, such as PTBD and EUS-BD, is necessary to respond to failure in these cases. This article is protected by copyright. All rights reserved.


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