Double balloon enteroscopy improves ERCP success in patients with modified small bowel anatomy

Abstract

OBJECTIVE: The aim of this study was to evaluate the effect of double-balloon enteroscopy (DBE) on the success of endoscopic retrograde cholangiopancreatography (ERCP) procedures in patients with surgically modified gastrointestinal (GI)tract anatomy.METHODS: The medical records of patients who underwent ERCP in the Gastroenterology Department of Kocaeli UniversitySchool of Medicine hospital between December 2008 and September 2014 were examined. From the patient group that wasscheduled to undergo DBE-ERCP, the details of cases in which ERCP via standard duodenoscope or DBE-ERCP was performedduring the same session because standard ERCP failed were included. Procedure parameters, outcomes, and complicationsrelated to the procedure in both groups were analyzed. Patients who underwent the DBE-ERCP procedure directly, those whounderwent push enteroscopy, or gastroscopy to evaluate the GI tract anatomy before the day of ERCP, and who underwentDBE-ERCP on a day other than the initial ERCP session were excluded. Afferent loop intubation, access to the major papilla,selective cannulation, therapeutic success rates, and the effect of DBE on overall procedure success were evaluated.RESULTS: Fifty-one patients with a history of BII gastrojejunostomy and 11 patients with hepaticojejunostomy (with or without Roux-en-Y) were included in the study. In all patients, the ERCP procedure was initiated with a standard duodenoscope. Ifintubation of the afferent loop was unsuccessful in reaching the major papilla or enterobiliary anastomosis, DBE was used. In30 (48.4%) of the 62 patients whose GI tract was anatomically altered, the duodenoscope was successfully advanced to theampulla and 27 (43.5%) were cannulated successfully. Thirty-one patients underwent DBE-ERCP. DBE reached the ampullaor enterobiliary anastomosis in 30 patients (96.8%) and selective choledocus cannulation was achieved in all patients but3 (90%), including 1 patient with a hepaticojejunostomy. The overall ERCP success rate increased from 43.5% (27/62) to87.1% (54/62). Two perforations (1 during standard duodenoscopy and 1 with DBE-ERCP) were observed.CONCLUSION: The overall success rate of ERCP increased with use of the DBE technique in patients with small bowelanatomic variations that were the result of previous surgery.