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CC BY 4.0 · Endoscopy 2023; 55(S 01): E961-E962
DOI: 10.1055/a-2132-4897
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Novel motorized spiral enteroscopy-assisted ERCP in a case of surgically altered anatomy

Awanish Tewari
Institute of Gastrosciences and Liver Transplant, Apollo Multispeciality Hospitals, Kolkata, India
,
Vikram Uttam Patil
Institute of Gastrosciences and Liver Transplant, Apollo Multispeciality Hospitals, Kolkata, India
,
Mahesh Kumar Goenka
Institute of Gastrosciences and Liver Transplant, Apollo Multispeciality Hospitals, Kolkata, India
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Endoscopic retrograde cholangiopancreatography (ERCP) in patients with surgically altered anatomy is intrinsically challenging [1]. Pooled rates of technical success, clinical success, and adverse events with balloon-assisted ERCP are reported to be 71.4 %, 58.7 %, and 8.4 %, respectively [2]. We report a case where we successfully performed novel motorized spiral enteroscopy (NMSE)-assisted ERCP in a patient with surgically altered anatomy.

A 70-year-old man with gastric diffuse large B-cell lymphoma underwent partial gastrectomy with Roux-en-Y gastrojejunostomy followed by chemotherapy 10 years prior to the current admission. He presented this time with a 6-week history of severe upper abdominal pain, jaundice, and pruritus. Evaluation showed acute mild biliary pancreatitis, cholelithiasis with choledocholithiasis, and a polypoidal growth at the right vesico-ureteric junction. Magnetic resonance cholangiopancreatography showed chronic cholecystitis with choledocholithiasis ([Fig. 1]). We proceeded with NMSE (PSF-1; Olympus Medical Systems Corporation, Tokyo, Japan)-assisted ERCP via an antegrade route ([Video 1]).

Zoom Image
Fig. 1 Magnetic resonance cholangiopancreatography showing choledocholithiasis, elongated and large calculus, 1.6 × 0.8 cm, in the distal common bile duct (CBD; arrow) with dilated CBD (9.2 mm) and intrahepatic biliary radicals.

Video 1 Novel motorized spiral enteroscopy-assisted endoscopic retrograde cholangiopancreatography.


Qualität:

After identifying the anastomotic and jejunojenostomy sites ([Fig. 2 a]), the afferent (biliopancreatic) limb was entered. The biliary opening was noted at approximately 80 cm from the anastomosis. A triple-lumen sphincterotome was used to selectively cannulate the common bile duct (CBD) ([Fig. 2 b]). Cholangiogram revealed an oblong CBD calculus. Sphincteroplasty was performed, followed by balloon sweeps. A CBD calculus with concretions was removed ([Fig. 2 c]) and a biliary stent was deployed ([Fig. 2 d]). Total procedure duration was 40 minutes. No adverse events were noted. Jaundice resolved within a few days.

Zoom Image
Fig. 2 Common bile duct (CBD) clearance using motorized spiral enteroscopy-assisted endoscopic retrograde cholangiopancreatography. a Jejunojejunostomy site – afferent limb (green arrow) and efferent limb (yellow arrow). b Small periampullary diverticulum was noted, and selective CBD cannulation was performed using a triple-lumen sphincterotome. c Extracted CBD calculus. d Cholangiogram showing motorized spiral enteroscope with CBD stent (yellow arrows) after CBD clearance.

The patient underwent cystoscopy 2 days later, with transurethral resection of the bladder tumor and cystodiathermy. Biopsy revealed noninvasive papillary urothelial carcinoma. He then underwent laparoscopic cholecystectomy (histology revealed chronic cholecystitis).

After 6 weeks, NMSE-assisted ERCP was repeated and the CBD stent removed. The patient recovered well and was discharged.

In surgically altered anatomy, the normal ERCP procedure has limited success. NMSE-assisted ERCP can make the procedure more accessible.

Endoscopy_UCTN_Code_TTT_1AR_2AH and Endoscopy_UCTN_Code_TTT_1AP_2AD

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Artikel online veröffentlicht:
21. August 2023

© 2023. The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution License, permitting unrestricted use, distribution, and reproduction so long as the original work is properly cited. (https://creativecommons.org/licenses/by/4.0/)

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  • References

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