Balloon enteroscopy-assisted endoscopic retrograde cholangiopancreatography for the treatment of common bile duct stones in patients with roux-en-y gastrectomy: Outcomes and factors affecting complete stone extraction

Taisuke Obata, Koichiro Tsutsumi, Hironari Kato, Toru Ueki, Kazuya Miyamoto, Tatsuhiro Yamazaki, Akihiro Matsumi, Yuki Fujii, Kazuyuki Matsumoto, Shigeru Horiguchi, Kengo Yasugi, Tsuneyoshi Ogawa, Ryuta Takenaka, Hiroyuki Okada

Research output: Contribution to journalArticlepeer-review

Abstract

Background: Endoscopic retrograde cholangiopancreatography (ERCP) for extraction of common bile duct (CBD) stones in patients with Roux-en-Y gastrectomy (RYG) remains technically challenging. Methods: Seventy-nine RYG patients (median 79 years old) underwent short-type double-balloon enteroscopy-assisted ERCP (sDBE-ERCP) for CBD stones at three referral hospitals from 2011–2020. We retrospectively investigated the treatment outcomes and potential factors affecting complete stone extraction. Results: The initial success rates of reaching the papilla of Vater, biliary cannulation, and biliary intervention, including complete stone extraction or biliary stent placement, were 92%, 81%, and 78%, respectively. Of 57 patients with attempted stone extraction, complete stone extraction was successful in 74% for the first session and ultimately in 88%. The adverse events rate was 5%. The multivariate analysis indicated that the largest CBD diameter ≥14 mm (odds ratio (OR), 0.04; 95% confidence interval (CI), 0.01–0.58; p = 0.018) and retroflex position (OR, 6.43; 95% CI, 1.12–36.81; p = 0.037) were independent predictive factors affecting complete stone extraction achievement. Conclusions: Therapeutic sDBE-ERCP for CBD stones in a relatively elderly RYG cohort, was effective and safe. A larger CBD diameter negatively affected complete stone extraction, but using the retroflex position may be useful for achieving complete stone clearance.

Original languageEnglish
Article number3314
JournalJournal of Clinical Medicine
Volume10
Issue number15
DOIs
Publication statusPublished - Aug 1 2021

Keywords

  • Bile duct stone
  • Complete stone removal
  • Endoscopic retrograde cholangiography
  • Gastrectomy
  • Roux-en-Y anastomosis
  • Short-type balloon enteroscopy

ASJC Scopus subject areas

  • Medicine(all)

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