Rotational assisted endoscopic retrograde cholangiopancreatography in patients with reconstructivegastrointestinal surgical anatomy

• 作者: Majed El Zouhairi James B Watson Svetang V Desai David K Swartz Alejandra Castillo-Roth Mahfuzul Haque Paul S Jowell Malcolm S Branch Rebecca A Burbridge
• 来源期刊: 世界胃肠内镜杂志：英文版（电子版）
• 学科: 医学
• 关键词: Gastric bypass GASTROSTOMY Cholangiopancreatography ENDOSCOPIC retrograde Double-Balloon ENTEROSCOPY AMPULLA of VATER SPHINCTEROTOMY ENDOSCOPIC Pancreatitis Retrospective studies
• 年，卷（期）: 2015,（3）
• 页码范围: 278-282
• 页数: 5页
• 分类号: R

摘要

AIM： To evaluate the success rates of performingtherapy utilizing a rotational assisted enteroscopy devicein endoscopic retrograde cholangiopancreatography（ERCP） in surgically altered anatomy patients.METHODS： Between June 1, 2009 and November8, 2012, we performed 42 ERCPs with the use ofrotational enteroscopy for patients with alteredanatomy （39 with gastric bypass Roux-en-Y, 2 withBillroth Ⅱ gastrectomy, and 1 with hepaticojejunostomyassociated with liver transplant）. The indications forERCP were： choledocholithiasis： 13 of 42 （30.9%）,biliary obstruction suggested on imaging： 20 of 42（47.6%）, suspected sphincter of Oddi dysfunction： 4 of42 （9.5%）, abnormal liver enzymes： 1 of 42 （2.4%）,ascending cholangitis： 2 of 42 （4.8%）, and bile leak： 2of 42 （4.8%）. All procedures were completed with theOlympus SIF-Q180 enteroscope and the Endo-EaseDiscovery SB overtube produced by Spirus Medical.RESULTS： Successful visualization of the majorampulla was accomplished in 32 of 42 procedures（76.2%）. Cannulation of the bile duct was successfulin 26 of 32 procedures reaching the major ampulla（81.3%）. Successful therapeutic intervention wascompleted in 24 of 26 procedures in which the bile duct was cannulated （92.3%）. The overall intention to treat success rate was 64.3%. In terms of cannulation success, the intention to treat success rate was 61.5%. Ten out of forty two patients （23.8%） required admission to the hospital after procedure for abdominal pain and nausea, and 3 of those 10 patients （7.1%） had a diagnosis of post-ERCP pancreatitis. The average hospital stay was 3 d. CONCLUSION： It is reasonable to consider an attempt at rotational assisted ERCP prior to a surgical intervention to alleviate biliary complications in patients with altered surgical anatomy.