Clinical Study from Deparment of Gastroenterology Peking Uni.3rd
Ke Li, Yong-Hui Huang, Wei Yao , Hong Chang, Xue-Biao Huang, Yao-Peng Zhang, Zhi-Qiang Song
Department of Gastroenterology, Peking University Third Hospital, 49 North Garden Road, Haidian District, 100191 Beijing, China
The aim of this study was to evaluate the usefulness of adult colonoscopy or single- balloon enteroscopy (SBE)-assisted endoscopic retrograde cholangiopancreatography (ERCP) in long-limb surgical bypass patients.Retrospective analysis of 16 patients with long-limb surgical bypasses who underwent therapeutic ERCP because of suspected pancreaticobiliary diseases. Small-bowel intubation was performed by peroral adult colonoscopy or SBE. If colonoscopy success was achieved, ERCP was performed subsequently. But in patients using SBE, a small-caliber colonoscope would be used to replace enteroscope if the SBE success was achieved. ERCP was then performed with the conventional accessories.
Fig.1 A 34-year-old woman who had undergonestandard Whipple for pancreatic tumor 3 years ago presented with cholangitis.Endoscopic retrograde cholangiopancreatography using an adult colonoscope disclosed severe stricture at the bilioentericanastomosis.
Fig.2 After balloon dilation of stenotic anastomosis,the stones were removed using a stone retrieval basket.
Fig.3 A 50-year-old man who had undergone Roux-en-Y hepaticojejunostomy for obstructive jaundice 5 years ago presented with recurrent cholangitis.The enteroscope was replaced with a small-caliber colonoscope after the bilioen- teric(BE)anastomosis was reached with the single-balloon enteroscopy.Note the position relation between the BE anasto-mosis (arrowhead)and the front endof overtube(arrow). The latter must approach the BE anastomosis as far as possible.
Fig.4 One 7F stent was placed through the bilioenteric anastomosis.Note the front end of overtube(arrow).
A total of 21 ERCP procedures were performed. Adult colonoscope was used for ERCP in 8 patients with standard Whipple resection consecutively. Colonoscopy success was achieved in 8 of 8 patients (100%), of whom 7 of 8 (87.5%) achieved ERCP success. SBE-assisted ERCP was attempted in other 8 patients with different types of Roux-en-Y anatomy. SBE success was achieved in 7 of 8 patients (87.5%), of whom 4 of 7 (57.1%) achieved ERCP success. The overall success rate of endoscopy and ERCP was 93.8% (15/16) and 68.8% (11/16), respectively.Adult colonoscopy has high success rate for performing ERCP after Whipple resection and should be selected for such patient preferentially. By using the facilitated method for endoscopic interventions at pancreaticobiliary disease after Roux-en-Y reconstruction, SBE-assisted ERCP can be attempted when it is dif?cult to gain access to the papilla of Vater or bilioenteric/pancreaticoenteric anastomosis and long length ERCP accessories cannot be available.
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