Double balloon enteroscopy: a useful tool for diagnostic and therapeutic procedures in the pancreaticobiliary system.

Department of Medicine B, University of Muenster, Muenster, Germany.
The American Journal of Gastroenterology (Impact Factor: 9.21). 05/2008; 103(4):894-900. DOI: 10.1111/j.1572-0241.2007.01745.x
Source: PubMed

ABSTRACT Diagnostic and therapeutic interventions in the biliary and pancreatic system in the previously operated patient by conventional endoscopic retrograde cholangiopancreaticography (ERCP) are difficult and, depending on the surgical procedure, in many cases unsuccessful. We describe our experience of ERCP performed with a double balloon enteroscope (DBE) as an alternative examination technique for these patients.
In a retrospective analysis of all DBE procedures at our department between November 2004 and June 2007, 11 patients were identified with various anatomic variations in whom ERCP was performed using a DBE.
In 72% of the patients, previous conventional ERCP examinations failed (8/11). In these patients, DBE-ERCP was successful in 63%. The overall success rate of DBE-ERCP in all patients was 64% (7/11 patients). In those patients, interventions such as papillotomy, calculus extractions, as well as stent placement could be performed even though tools for DBE-ERCP are still very limited. Despite most of the DBE-ERCPs having included therapeutic interventions, no major complications occurred in our case series and minor side effects were restricted to meteorism and mild to moderate abdominal pain.
DBE-ERCP is an alternative method for diagnostic as well as therapeutic interventions in the biliary as well pancreatic system in the operated patient. However, it should be limited to selected patients, e.g., with contraindications for PTC, as it is a time-consuming as well as a cost-intensive procedure.

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    ABSTRACT: Development of strictures of hepaticojejunal anastomoses (HJA) is observed in 6-30% of patients and mortality after repeated reconstructive interventions ranges from 13% to 25%. Double balloon enteroscopy (DBE) allows one to visualize the zone of Roux-en-Y anastomosis after reconstructive operations on the bile ducts for differentiation between stricture of HJA and recurrent cholangitis.
    06/2014; 9(2):219-25.
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    ABSTRACT: Background and AimEndoscopic retrograde cholangiopancreatography (ERCP) in patients with surgically altered anatomy is still challenging. We aimed to clarify the current status of ERCP in Japan in patients with surgically altered anatomy.Methods Questionnaire survey was conducted in 2012 at 11 participating facilities regarding ERCP in patients with surgically altered anatomy.ResultsA total of 490 ERCP procedures were carried out in 273 patients with surgically altered anatomy. The breakdown of surgical procedures was as follows: Roux-en-Y (R-Y) reconstruction (n = 154 [31.4%]), pancreaticoduodenectomy (PD) (n = 136 [27.8%]), hepaticojejunostomy (n = 103 [21.0%]), liver transplantation (n = 20 [4.1%]), Billroth II reconstruction (n = 69 [14.1%]), and interposition after total gastrectomy (n = 8 [1.6%]). The overall success rate of reaching the target site was 91.8% (450 of 490 ERCP procedures). According to reconstructive surgical procedures, the target site was reached in 138 of 154 procedures (89.6%) for R-Y reconstruction, 129 of 136 procedures (94.8%) for PD, 89 of 103 procedures (86.4%) for hepaticojejunostomy, 18 of 20 procedures (90.0%) for liver transplantation, 68 of 69 procedures (98.6%) for Billroth II reconstruction, and eight of eight procedures (100%) for interposition after total gastrectomy.Conclusions The success rate of reaching the target site was high in patients with Billroth II reconstruction and low in patients with hepaticojejunostomy. Although the success rate of endoscopic insertion for ERCP in patients with surgically altered anatomy was high, there are still cases in which it is difficult to achieve technical success.
    Digestive Endoscopy 04/2014; 26(S2). · 1.61 Impact Factor
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    ABSTRACT: Background and AimIn patients with Roux-en-Y hepaticojejunostomy (HJ with R-Y) and Whipple resection, endoscopic retrograde cholangiopancreatography (ERCP) can be challenging. We report our experience with ERCP using balloon-assisted enteroscopy (BAE) (BAE-ERCP) in patients with HJ with R-Y, and Whipple resection.MethodsBAE-ERCP procedures were carried out in 62 patients (HJ with R-Y : Whipple resection = 34:28).ResultsOverall, the rates of reaching the anastomosis were 85.3% (29/34) in HJ with R-Y and 96.4% (27/28) in Whipple resection. In terms of HJ with R-Y, insertion success rate by standard single-balloon enteroscopy (SBE) was 89.3% (25/28). Insertion success rate by short BAE, including SBE and double-balloon enteroscopy (DBE), was 50% (3/6). There was a statistically significant difference of insertion success rate between standard long BE and short BE (P = 0.021). However, in the Whipple patients, insertion success rate by standard and short SBE was 93.8% (15/16) and 91.7% (11/12), respectively. Initial insertion success rate by short BAE in Whipple patients was significantly higher than in HJ with R-Y (91.7% vs 50%, P = 0.045). Therapeutic interventions included dilation of anastomosis stricture, stone extraction, endoscopic mechanical lithotripsy, biliary stent placement, stent extraction, endoscopic nasobiliary drainage, direct cholangioscopy, and electrohydraulic lithotripsy. Our HJ with R-Y series and Whipple series treatment success rate was 90% (18/20) and 95.0% (19/20), respectively.ConclusionsBAE-ERCP enabled ERCP to be carried out in patients with HJ. It is considered safe and feasible. Further experience and device improvement are needed.
    Digestive Endoscopy 04/2014; 26(S2). · 1.61 Impact Factor

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