Endoscopic Treatment of Biliopancreatic Pathology In Patients With Previous Whipple’S Duodenopancreatectomy: Lessons Learned From Single-Balloon Enteroscopy-Assisted ERCP

Aims Endoscopic treatment of subsequent biliopancreatic pathology is challenging due to altered anatomy in Whipple’s duodenopancreatectomy. To evaluate feasibility and safety of single-balloon enteroscopy-assisted ERCP (SBE-ERCP) to treat biliary and/or pancreatic pathology after Whipple’s duodenopancreatectomy.

Methods Retrospective analysis of 41 patients with Whipple’s anatomic variations who underwent SBE-ERCP from October 2014 to October 2020. Technical and clinical success rates and adverse events were evaluated.

Results There were 29 patients with a biliary indication, 8 pancreatic and 4 both biliary and pancreatic. Biliary ERCP was performed in 33 (73 %) and pancreatic ERCP in 12 (27 %) patients. In the biliary group male/female ratio was 23/10 with mean age of 66 (32-84) years. A total of 71 ERCP procedures were performed with a technical success rate in 63/71 (88.7 %) of the procedures and a clinical success rate in 30/33 (90.9 %) of the patients. Mild adverse events were self-limiting cholangitis and abdominal pain in 9/71 (13.7 %) procedures. There were no serious adverse events. In the pancreatic group male/female ratio was 5/7 with mean age of 63 (53-80) years. A total of 19 ERCP procedures were performed with a technical success rate in 13/19 (68.4 %) of the procedures (p=0.030 Chi-square vs. biliary ERCP) and a clinical success rate in 7/12 (58.3 %) of the patients (p=0.012 Chi-square vs. biliary ERCP). Mild adverse events were self-limiting pancreatitis or abdominal pain in 5/19 (26.3 %) procedures (p=0.145 Chi-square vs. biliary ERCP). There were no serious adverse events.

Conclusions Biliopancreatic pathology in patients with Whipple’s duodenopancreatectomy can be dealt with using SBE-ERPC. Technical and clinical success rates are high (±90 %) for biliary indications, whereas they are lower (<70 %) for pancreatic indications. It is a very safe procedure with only mild adverse events. SBE-ERCP can be considered to treat biliopancreatic pathology in patients with Whipple’s duodenopancreatectomy.

Citation Garcés-Duran R, Monino L, Deprez P et al. eP353 ENDOSCOPIC TREATMENT OF BILIOPANCREATIC PATHOLOGY IN PATIENTS WITH PREVIOUS WHIPPLE’S DUODENOPANCREATECTOMY: LESSONS LEARNED FROM SINGLE-BALLOON ENTEROSCOPY-ASSISTED ERCP. Endoscopy 2021; 53: S212.

Publication History

Article published online:
19 March 2021