ERCP using a short double-balloon enteroscope in patients with prior pancreatoduodenectomy: higher maneuverability supplied by the efferent-limb route

Koichiro Tsutsumi, Hironari Kato, Shinichiro Muro, Naoki Yamamoto, Yasuhiro Noma, Shigeru Horiguchi, Ryo Harada, Hiroyuki Okada, Kazuhide Yamamoto

Research output: Contribution to journalArticle

8 Citations (Scopus)

Abstract

Background: In endoscopic retrograde cholangiopancreatography (ERCP) for patients who have undergone a pancreatoduodenectomy (PD) with a Braun anastomosis, two different approaches are available: the afferent-limb route and the efferent-limb route. This study was to clarify the usefulness of a short double-balloon enteroscope (DBE) in ERCP for prior-PD patients, and to reveal which route was optimal for ERCP. Methods: Seventy-two consecutive patients with a prior PD underwent diagnostic or therapeutic ERCP using the DBE. This retrospective study evaluated the outcome of the ERCP and assessed the shape of the DBE by fluoroscopic imaging to compare the maneuverability of the two routes. Results: In 71 patients (99 %) the bilioenteric anastomosis was reached and cholangiography was performed. Treatment was required in 59 patients (83 %) and was performed successfully in all. Complications occurred in two patients (3 %) with cholangitis. In three patients, the afferent-limb route had to be changed to the efferent-limb route in the procedure. A gentler arc-shaped angulation of the DBE was induced using the efferent-limb route compared to the afferent-limb route (128° (n = 42) vs. 113° (n = 15); p = 0.037), and that was also revealed in 11 patients (15 %) who underwent repeated ERCP by each route (123° vs. 96°; p = 0.003). Conclusions: The short DBE facilitates ERCP in prior-PD patients. Particularly, ERCP using the efferent-limb route can achieve a maneuverable procedure without unnecessary stress, such as scope insertion to the sharp-angled afferent limb and the handling of various accessories through the narrow scope channel with a sense of resistance.

Original languageEnglish
Pages (from-to)1944-1951
Number of pages8
JournalSurgical Endoscopy
Volume29
Issue number7
DOIs
Publication statusPublished - Jul 19 2015

Keywords

  • Braun anastomosis
  • Endoscopic retrograde cholangiopancreatography (ERCP)
  • Maneuverability
  • Pancreatoduodenectomy (PD)
  • Short double-balloon enteroscopy (DBE)

ASJC Scopus subject areas

  • Surgery

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