RSS-Feed abonnieren
DOI: 10.1055/s-0043-117406
Comparison of two fluoroscopic images to ensure efficient scope insertion for biliary intervention in patients with Roux-en-Y hepaticojejunostomy
Publikationsverlauf
submitted 09. März 2017
accepted after revision 30. Juni 2017
Publikationsdatum:
12. September 2017 (online)
![](https://www.thieme-connect.de/media/endoscopy/201712/lookinside/thumbnails/15478_10-1055-s-0043-117406-1.jpg)
Abstract
Background and study aims No standard procedure for endoscopic retrograde cholangiopancreatography is available for patients with Roux-en-Y hepaticojejunostomy (RYHJ) with side-to-end hepaticojejunostomy. We therefore explored methods of efficient scope insertion at a hepaticojejunostomy site.
Patients and methods Patients with suspected biliary disease were prospectively enrolled. Based on two fluoroscopic images obtained on scope insertion into each lumen of a two-pronged Roux-en-Y anastomosis, we selected the lumen in which the distal end of the scope progressed toward the patient’s liver or head. The accuracy of this method for selecting the correct lumen leading to the hepaticojejunostomy site was investigated.
Results Of the 33 included patients, successful insertion to the hepaticojejunostomy site was achieved in 32 (97 %), 26 (81 %) of whom had undergone the imaging method. The accuracy of the method was 88 % (23/26). The time required for insertion between the anastomotic site and the hepaticojejunostomy site was shorter when the lumen selection had been correct (13 minutes [7 – 30] (n = 23) vs. 18 minutes [8 – 28] (n = 9); P = 0.95).
Conclusion This method based on two fluoroscopic images was useful for achieving efficient scope insertion in patients with RYHJ.
Trial registered at University Hospital Medical Information Network Clinical Trials Registry (UMIN000014183).
-
References
- 1 Shimatani M, Hatanaka H, Kogure H. et al. Diagnostic and therapeutic endoscopic retrograde cholangiography using a short-type double-balloon endoscope in patients with altered gastrointestinal anatomy: a multicenter prospective study in Japan. Am J Gastroenterol 2016; 111: 1750-1758
- 2 Itoi T, Ishii K, Sofuni A. et al. Single-balloon enteroscopy-assisted ERCP in patients with Billroth II gastrectomy or Roux-en-Y anastomosis (with video). Am J Gastroenterol 2010; 105: 93-99
- 3 Siddiqui AA, Chaaya A, Shelton C. et al. Utility of the short double-balloon enteroscope to perform pancreaticobiliary interventions in patients with surgically altered anatomy in a US multicenter study. Dig Dis Sci 2013; 58: 858-864
- 4 Aabakken L, Bretthauer M, Line PD. Double-balloon enteroscopy for endoscopic retrograde cholangiography in patients with a Roux-en-Y anastomosis. Endoscopy 2007; 39: 1068-1071
- 5 Mönkemüller K. Endoscopic retrograde cholangiopancreatography with balloon-assisted enteroscope in patients with surgically altered upper GI anatomy. Video Journal and Encyclopedia of GI Endoscopy 2013; 1: 476-478
- 6 Mönkemüller K, Fry LC, Bellutti M. et al. ERCP with the double balloon enteroscope in patients with Roux-en-Y anastomosis. Surg Endosc 2009; 23: 1961-1967
- 7 Kuga R, Safatle-Ribeiro AV, Faintuch J. et al. Endoscopic findings in the excluded stomach after Roux-en-Y gastric bypass surgery. Arch Surg 2007; 142: 942-946
- 8 Skinner M, Popa D, Neumann H. et al. ERCP with the overtube-assisted enteroscopy technique: a systematic review. Endoscopy 2014; 46: 560-572
- 9 Hatanaka H, Yano T, Tamada K. Tips and tricks of double-balloon endoscopic retrograde cholangiopancreatography (with video). J Hepatobiliary Pancreat Sci 2015; 22: E28-E34
- 10 Cotton PB, Eisen GM, Aabakken L. et al. A lexicon for endoscopic adverse events: report of an ASGE workshop. Gastrointest Endosc 2010; 71: 446-454
- 11 Yano T, Hatanaka H, Yamamoto H. et al. Intraluminal injection of indigo carmine facilitates identification of the afferent limb during double-balloon ERCP. Endoscopy 2012; 44: E340-E341
- 12 Fukuba N, Moriyama I, Ishihara S. et al. Carbon enterography: a useful method for double-balloon enteroscopy-assisted ERCP. Endoscopy 2014; 46: E587-E588
- 13 Shimatani M, Takaoka M, Okazaki K. Tips for double balloon enteroscopy in patients with Roux-en-Y reconstruction and modified child surgery. J Hepatobiliary Pancreat Sci 2014; 21: E22-E28
- 14 Khashab MA, El Zein MH, Sharzehi K. et al. EUS-guided biliary drainage or enteroscopy-assisted ERCP in patients with surgical anatomy and biliary obstruction: an international comparative study. Endosc Int Open 2016; 4: E1322-E1327
- 15 Tsutsumi K, Kato H, Okada H. Side-to-side jejunojejunostomy is favorable for scope insertion during endoscopic retrograde cholangiopancreatography in patients with Roux-en-Y hepaticojejunostomy. Dig Endosc 2015; 27: 708