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A multicenter, U.S. experience of single-balloon, double-balloon, and rotational overtube-assisted enteroscopy ERCP in patients with surgically altered pancreaticobiliary anatomy (with video).
Shah, Raj J; Smolkin, Maximiliano; Yen, Roy; Ross, Andrew; Kozarek, Richard A; Howell, Douglas A; Bakis, Gennadiy; Jonnalagadda, Sreenivasan S; Al-Lehibi, Abed A; Hardy, Al; Morgan, Douglas R; Sethi, Amrita; Stevens, Peter D; Akerman, Paul A; Thakkar, Shyam J; Brauer, Brian C.
Afiliação
  • Shah RJ; Division of Gastroenterology and Hepatology, University of Colorado Anschutz Medical Campus, Aurora, CO 80045, USA. raj.shah@ucdenver.edu
Gastrointest Endosc ; 77(4): 593-600, 2013 Apr.
Article em En | MEDLINE | ID: mdl-23290720
ABSTRACT

BACKGROUND:

Data on overtube-assisted enteroscopy to facilitate ERCP in patients with surgically altered pancreaticobiliary anatomy, or long-limb surgical bypass, is limited.

OBJECTIVE:

To evaluate and compare ERCP success by using single-balloon (SBE), double-balloon (DBE), or rotational overtube enteroscopy.

DESIGN:

Consecutive patients identified retrospectively.

SETTING:

Eight U.S. referral centers. PATIENTS Long-limb surgical bypass patients with suspected pancreaticobiliary diseases. INTERVENTION Overtube-assisted enteroscopy ERCP. MAIN OUTCOME MEASUREMENTS Enteroscopy success visualizing the pancreaticobiliary-enteric anastomosis or papilla. ERCP success completing the intended pancreaticobiliary intervention. Clinical success greater than 50% reduction in abdominal pain or level of hepatic enzyme elevations or resolution of jaundice.

RESULTS:

From January 2008 through October 2009, 129 patients had 180 enteroscopy-ERCPs. Anatomy was Roux-en-Y gastric bypass (n = 63), hepaticojejunostomy (n = 45), postgastrectomy (n = 6), Whipple procedure (n = 10), and other (n = 5). ERCP success was 81 of 129 (63%). Enteroscopy success 92 of 129 (71%), of whom 81 of 92 (88%) achieved ERCP success. Reasons for ERCP failure (n = 48) afferent limb entered but pancreaticobiliary anastomosis and/or papilla not reached (n = 23), cannulation failure (n = 11), afferent limb angulation (n = 8), and jejunojejunostomy not identified (n = 6). Select

interventions:

anastomotic stricturoplasty (cautery ± dilation, n = 16), stone removal (n = 21), stent (n = 25), and direct cholangioscopy (n = 11). ERCP success rates were similar between Roux-en-Y gastric bypass and other long-limb surgical bypass and among SBE, DBE, and rotational overtube enteroscopy. Complications were 16 of 129, 12.4%.

LIMITATIONS:

Retrospective study.

CONCLUSION:

(1) ERCP is successful in nearly two-thirds of long-limb surgical bypass patients and in 88% when the papilla or pancreaticobiliary-enteric anastomosis is reached. (2) Enteroscopy success in long-limb surgical bypass is similar among SBE, DBE, and rotational overtube enteroscopy methods. (3) Referral of long-limb surgical bypass patients who require ERCP to high-volume institutions may be considered before more invasive percutaneous or surgical alternatives.
Assuntos

Texto completo: 1 Base de dados: MEDLINE Assunto principal: Pâncreas / Ductos Biliares / Endoscopia Gastrointestinal / Colangiopancreatografia Retrógrada Endoscópica / Endoscópios Gastrointestinais Idioma: En Ano de publicação: 2013 Tipo de documento: Article

Texto completo: 1 Base de dados: MEDLINE Assunto principal: Pâncreas / Ductos Biliares / Endoscopia Gastrointestinal / Colangiopancreatografia Retrógrada Endoscópica / Endoscópios Gastrointestinais Idioma: En Ano de publicação: 2013 Tipo de documento: Article