TY - JOUR
T1 - A multicenter, U.S. experience of single-balloon, double-balloon, and rotational overtube-assisted enteroscopy ERCP in patients with surgically altered pancreaticobiliary anatomy (with video)
AU - Shah, Raj J.
AU - Smolkin, Maximiliano
AU - Yen, Roy
AU - Ross, Andrew
AU - Kozarek, Richard A.
AU - Howell, Douglas A.
AU - Bakis, Gennadiy
AU - Jonnalagadda, Sreenivasan S.
AU - Al-Lehibi, Abed A.
AU - Hardy, Al
AU - Morgan, Douglas R.
AU - Sethi, Amrita
AU - Stevens, Peter D.
AU - Akerman, Paul A.
AU - Thakkar, Shyam J.
AU - Brauer, Brian C.
N1 - Funding Information:
DISCLOSURE: R. Shah received a consulting and educational grant from Cook and educational grants from Olympus and Pentax . A. Ross received honoraria from Olympus and Cook . R. Kozarek received educational grants from Cook and Olympus . D. Howell is a consultant for Olympus and has a consultant and royalty agreement with Cook. S. Jonnalagadda is a speaker for Olympus. D. Morgan received a research grant from Spirus, Inc . P. Akerman is a consultant for Spirus, Inc. No other financial relationships relevant to this publication were disclosed.
PY - 2013/4
Y1 - 2013/4
N2 - Background: Data on overtube-assisted enteroscopy to facilitate ERCP in patients with surgically altered pancreaticobiliary anatomy, or long-limb surgical bypass, is limited. Objective: To evaluate and compare ERCP success by using single-balloon (SBE), double-balloon (DBE), or rotational overtube enteroscopy. Design: Consecutive patients identified retrospectively. Setting: Eight U.S. referral centers. Patients: Long-limb surgical bypass patients with suspected pancreaticobiliary diseases. Intervention: Overtube-assisted enteroscopy ERCP. Main Outcome Measurements: Enteroscopy success: visualizing the pancreaticobiliary-enteric anastomosis or papilla. ERCP success: completing the intended pancreaticobiliary intervention. Clinical success: greater than 50% reduction in abdominal pain or level of hepatic enzyme elevations or resolution of jaundice. Results: From January 2008 through October 2009, 129 patients had 180 enteroscopy-ERCPs. Anatomy was Roux-en-Y: gastric bypass (n = 63), hepaticojejunostomy (n = 45), postgastrectomy (n = 6), Whipple procedure (n = 10), and other (n = 5). ERCP success was 81 of 129 (63%). Enteroscopy success: 92 of 129 (71%), of whom 81 of 92 (88%) achieved ERCP success. Reasons for ERCP failure (n = 48): afferent limb entered but pancreaticobiliary anastomosis and/or papilla not reached (n = 23), cannulation failure (n = 11), afferent limb angulation (n = 8), and jejunojejunostomy not identified (n = 6). Select interventions: anastomotic stricturoplasty (cautery ± dilation, n = 16), stone removal (n = 21), stent (n = 25), and direct cholangioscopy (n = 11). ERCP success rates were similar between Roux-en-Y gastric bypass and other long-limb surgical bypass and among SBE, DBE, and rotational overtube enteroscopy. Complications were 16 of 129, 12.4%. Limitations: Retrospective study. Conclusion: (1) ERCP is successful in nearly two-thirds of long-limb surgical bypass patients and in 88% when the papilla or pancreaticobiliary-enteric anastomosis is reached. (2) Enteroscopy success in long-limb surgical bypass is similar among SBE, DBE, and rotational overtube enteroscopy methods. (3) Referral of long-limb surgical bypass patients who require ERCP to high-volume institutions may be considered before more invasive percutaneous or surgical alternatives.
AB - Background: Data on overtube-assisted enteroscopy to facilitate ERCP in patients with surgically altered pancreaticobiliary anatomy, or long-limb surgical bypass, is limited. Objective: To evaluate and compare ERCP success by using single-balloon (SBE), double-balloon (DBE), or rotational overtube enteroscopy. Design: Consecutive patients identified retrospectively. Setting: Eight U.S. referral centers. Patients: Long-limb surgical bypass patients with suspected pancreaticobiliary diseases. Intervention: Overtube-assisted enteroscopy ERCP. Main Outcome Measurements: Enteroscopy success: visualizing the pancreaticobiliary-enteric anastomosis or papilla. ERCP success: completing the intended pancreaticobiliary intervention. Clinical success: greater than 50% reduction in abdominal pain or level of hepatic enzyme elevations or resolution of jaundice. Results: From January 2008 through October 2009, 129 patients had 180 enteroscopy-ERCPs. Anatomy was Roux-en-Y: gastric bypass (n = 63), hepaticojejunostomy (n = 45), postgastrectomy (n = 6), Whipple procedure (n = 10), and other (n = 5). ERCP success was 81 of 129 (63%). Enteroscopy success: 92 of 129 (71%), of whom 81 of 92 (88%) achieved ERCP success. Reasons for ERCP failure (n = 48): afferent limb entered but pancreaticobiliary anastomosis and/or papilla not reached (n = 23), cannulation failure (n = 11), afferent limb angulation (n = 8), and jejunojejunostomy not identified (n = 6). Select interventions: anastomotic stricturoplasty (cautery ± dilation, n = 16), stone removal (n = 21), stent (n = 25), and direct cholangioscopy (n = 11). ERCP success rates were similar between Roux-en-Y gastric bypass and other long-limb surgical bypass and among SBE, DBE, and rotational overtube enteroscopy. Complications were 16 of 129, 12.4%. Limitations: Retrospective study. Conclusion: (1) ERCP is successful in nearly two-thirds of long-limb surgical bypass patients and in 88% when the papilla or pancreaticobiliary-enteric anastomosis is reached. (2) Enteroscopy success in long-limb surgical bypass is similar among SBE, DBE, and rotational overtube enteroscopy methods. (3) Referral of long-limb surgical bypass patients who require ERCP to high-volume institutions may be considered before more invasive percutaneous or surgical alternatives.
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U2 - 10.1016/j.gie.2012.10.015
DO - 10.1016/j.gie.2012.10.015
M3 - Article
C2 - 23290720
AN - SCOPUS:84875225974
SN - 0016-5107
VL - 77
SP - 593
EP - 600
JO - Gastrointestinal endoscopy
JF - Gastrointestinal endoscopy
IS - 4
ER -