Endoscopic Retrograde Cholangiopancreatography Using the Single Balloon Enteroscope Technique in Patients with Roux-en-Y Anastomosis

Abstract

BACKGROUND: Endoscopic retrograde cholangiopancreatography (ERCP) is technically challenging or impossible in patients with complex postsurgical anatomy. The aim of this cohort study was to assess the technical success of ERCP with the single balloon enteroscope (SBE) in patients with Roux-en-Y anastomosis. PATIENTS: Patients with Roux-en-Y anastomosis presenting with cholestasis undergoing ERCP with the SBE technique in a tertiary university hospital. Diagnostic success was defined as successful duct cannulation or securing the diagnosis and therapeutic success was defined as the ability to successfully accomplish endoscopic therapy. RESULTS: ERCP using the SBE was performed on 17 occasions in 13 patients (5 F, 8 M, mean age 66.5 years, range 25-77) with Roux-en-Y anastomosis. Indications for ERCP were biliary obstruction with common bile duct stones and/or cholangitis in all patients. The diagnostic success was 61.5% and the therapeutic success was 53.8%. Therapeutic interventions included dilation of common bile duct stenosis with a balloon (n = 4), biliary stent insertion (n = 2), removal of bile duct stones (n = 2), stent retrieval (n = 2), papillectomy (n = 1), and sphincterotomy (n = 1). No major complications occurred. CONCLUSIONS: ERCP using the SBE is feasible in patients with altered postsurgical anatomy presenting with biliary problems permitting diagnostic and therapeutic interventions.