Potential Factors Affecting Results of Short-Type Double-Balloon Endoscope-Assisted Endoscopic Retrograde Cholangiopancreatography

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Abstract

Background: Short-type double-balloon endoscope (DBE)-assisted endoscopic retrograde cholangiopancreatography (ERCP) has been developed as an alternative approach for cases with a surgically altered gastrointestinal anatomy. However, this technique is sometimes technically challenging and carries a risk of severe adverse events. Aims: To evaluate the factors affecting the technical success rate and adverse events of DBE-ERCP. Methods: A total of 319 patients (805 procedures) with a surgically altered gastrointestinal anatomy underwent short DBE-ERCP. The factors affecting the technical success rate and adverse events, and the learning curve of the trainees were retrospectively evaluated. Results: The technical success rate of all procedures was 90.7%. Adverse events occurred in 44 (5.5%) procedures. A multivariate analysis indicated that Roux-en-Y reconstruction and first-time short DBE-ERCP were factors affecting the technical failure and adverse event rates, while the modified Child method after subtotal stomach-preserving pancreaticoduodenectomy reconstruction was a non-risk factor for adverse events. The trainee caseload did not affect the technical success or adverse event rates significantly; however, trainees tended to perform cases involving the modified Child method after subtotal stomach-preserving pancreaticoduodenectomy reconstruction. The success rate of scope insertion increased according to experience; however, the overall success rate did not differ to a statistically significant extent. Conclusion: Short DBE-ERCP was useful and safe for managing cases with a surgically altered anatomy; however, trainees should concentrate on accumulating experience with easy cases, such as those with the modified Child method after subtotal stomach-preserving pancreaticoduodenectomy reconstruction or a history of DBE-ERCP.

Original languageEnglish
JournalDigestive Diseases and Sciences
DOIs
Publication statusAccepted/In press - Jan 1 2019

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Endoscopes
Endoscopic Retrograde Cholangiopancreatography
Pancreaticoduodenectomy
Anatomy
Stomach
Learning Curve
Multivariate Analysis

Keywords

  • Biliary tract diseases
  • Double-balloon enteroscopy
  • Endoscopic retrograde cholangiopancreatography
  • Pancreatic diseases
  • Surgically altered anatomy

ASJC Scopus subject areas

  • Physiology
  • Gastroenterology

Cite this

@article{e1601c22f7a24f1b9ad8b62d450203e5,
title = "Potential Factors Affecting Results of Short-Type Double-Balloon Endoscope-Assisted Endoscopic Retrograde Cholangiopancreatography",
abstract = "Background: Short-type double-balloon endoscope (DBE)-assisted endoscopic retrograde cholangiopancreatography (ERCP) has been developed as an alternative approach for cases with a surgically altered gastrointestinal anatomy. However, this technique is sometimes technically challenging and carries a risk of severe adverse events. Aims: To evaluate the factors affecting the technical success rate and adverse events of DBE-ERCP. Methods: A total of 319 patients (805 procedures) with a surgically altered gastrointestinal anatomy underwent short DBE-ERCP. The factors affecting the technical success rate and adverse events, and the learning curve of the trainees were retrospectively evaluated. Results: The technical success rate of all procedures was 90.7{\%}. Adverse events occurred in 44 (5.5{\%}) procedures. A multivariate analysis indicated that Roux-en-Y reconstruction and first-time short DBE-ERCP were factors affecting the technical failure and adverse event rates, while the modified Child method after subtotal stomach-preserving pancreaticoduodenectomy reconstruction was a non-risk factor for adverse events. The trainee caseload did not affect the technical success or adverse event rates significantly; however, trainees tended to perform cases involving the modified Child method after subtotal stomach-preserving pancreaticoduodenectomy reconstruction. The success rate of scope insertion increased according to experience; however, the overall success rate did not differ to a statistically significant extent. Conclusion: Short DBE-ERCP was useful and safe for managing cases with a surgically altered anatomy; however, trainees should concentrate on accumulating experience with easy cases, such as those with the modified Child method after subtotal stomach-preserving pancreaticoduodenectomy reconstruction or a history of DBE-ERCP.",
keywords = "Biliary tract diseases, Double-balloon enteroscopy, Endoscopic retrograde cholangiopancreatography, Pancreatic diseases, Surgically altered anatomy",
author = "Daisuke Uchida and Koichiro Tsutsumi and Hironari Kato and Akihiro Matsumi and Yosuke Saragai and Takeshi Tomoda and Kazuyuki Matsumoto and Shigeru Horiguchi and Hiroyuki Okada",
year = "2019",
month = "1",
day = "1",
doi = "10.1007/s10620-019-05857-3",
language = "English",
journal = "American Journal of Digestive Diseases",
issn = "0002-9211",
publisher = "Springer New York",

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TY - JOUR

T1 - Potential Factors Affecting Results of Short-Type Double-Balloon Endoscope-Assisted Endoscopic Retrograde Cholangiopancreatography

AU - Uchida, Daisuke

AU - Tsutsumi, Koichiro

AU - Kato, Hironari

AU - Matsumi, Akihiro

AU - Saragai, Yosuke

AU - Tomoda, Takeshi

AU - Matsumoto, Kazuyuki

AU - Horiguchi, Shigeru

AU - Okada, Hiroyuki

PY - 2019/1/1

Y1 - 2019/1/1

N2 - Background: Short-type double-balloon endoscope (DBE)-assisted endoscopic retrograde cholangiopancreatography (ERCP) has been developed as an alternative approach for cases with a surgically altered gastrointestinal anatomy. However, this technique is sometimes technically challenging and carries a risk of severe adverse events. Aims: To evaluate the factors affecting the technical success rate and adverse events of DBE-ERCP. Methods: A total of 319 patients (805 procedures) with a surgically altered gastrointestinal anatomy underwent short DBE-ERCP. The factors affecting the technical success rate and adverse events, and the learning curve of the trainees were retrospectively evaluated. Results: The technical success rate of all procedures was 90.7%. Adverse events occurred in 44 (5.5%) procedures. A multivariate analysis indicated that Roux-en-Y reconstruction and first-time short DBE-ERCP were factors affecting the technical failure and adverse event rates, while the modified Child method after subtotal stomach-preserving pancreaticoduodenectomy reconstruction was a non-risk factor for adverse events. The trainee caseload did not affect the technical success or adverse event rates significantly; however, trainees tended to perform cases involving the modified Child method after subtotal stomach-preserving pancreaticoduodenectomy reconstruction. The success rate of scope insertion increased according to experience; however, the overall success rate did not differ to a statistically significant extent. Conclusion: Short DBE-ERCP was useful and safe for managing cases with a surgically altered anatomy; however, trainees should concentrate on accumulating experience with easy cases, such as those with the modified Child method after subtotal stomach-preserving pancreaticoduodenectomy reconstruction or a history of DBE-ERCP.

AB - Background: Short-type double-balloon endoscope (DBE)-assisted endoscopic retrograde cholangiopancreatography (ERCP) has been developed as an alternative approach for cases with a surgically altered gastrointestinal anatomy. However, this technique is sometimes technically challenging and carries a risk of severe adverse events. Aims: To evaluate the factors affecting the technical success rate and adverse events of DBE-ERCP. Methods: A total of 319 patients (805 procedures) with a surgically altered gastrointestinal anatomy underwent short DBE-ERCP. The factors affecting the technical success rate and adverse events, and the learning curve of the trainees were retrospectively evaluated. Results: The technical success rate of all procedures was 90.7%. Adverse events occurred in 44 (5.5%) procedures. A multivariate analysis indicated that Roux-en-Y reconstruction and first-time short DBE-ERCP were factors affecting the technical failure and adverse event rates, while the modified Child method after subtotal stomach-preserving pancreaticoduodenectomy reconstruction was a non-risk factor for adverse events. The trainee caseload did not affect the technical success or adverse event rates significantly; however, trainees tended to perform cases involving the modified Child method after subtotal stomach-preserving pancreaticoduodenectomy reconstruction. The success rate of scope insertion increased according to experience; however, the overall success rate did not differ to a statistically significant extent. Conclusion: Short DBE-ERCP was useful and safe for managing cases with a surgically altered anatomy; however, trainees should concentrate on accumulating experience with easy cases, such as those with the modified Child method after subtotal stomach-preserving pancreaticoduodenectomy reconstruction or a history of DBE-ERCP.

KW - Biliary tract diseases

KW - Double-balloon enteroscopy

KW - Endoscopic retrograde cholangiopancreatography

KW - Pancreatic diseases

KW - Surgically altered anatomy

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U2 - 10.1007/s10620-019-05857-3

DO - 10.1007/s10620-019-05857-3

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JO - American Journal of Digestive Diseases

JF - American Journal of Digestive Diseases

SN - 0002-9211

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