Endoscopic retrograde cholangiopancreatography with balloon-assisted enteroscopy in patients with Roux-en-Y anastomosis and Whipple operation.

In patients with Roux-en-Y (R-Y) anastomosis (including hepaticojejunostomy and R-Y gastric bypass) and Whipple operation, endoscopic retrograde cholangiopancreatography (ERCP) can be challenging. We retrospective analyses our experience with ERCP using balloon-assisted enteroscopy (BAE) (BAE-ERCP) in patients with R-Y anastomosis and Whipple operation.ERCP was performed in 15 patients (4 pancreaticoduodenectomy and 10cholangiojejunostomy and 1 Subtotal gastrectomy with R-Y reconstruction; age ranging from 4 to 63 years) with BAE. Double- and single-balloon enteroscopy was applied in 5 and 10 patients, respectively.Bile duct cannulation was successful in 13 of 15 cases (86.7%), including simple stenosis of the anastomotic stoma (n = 2), intrahepatic bile duct stones (n = 10), and pancreatic cancer (n = 1). Cannulation failed because the guidewire could not pass through the anastomotic stenosis in 1 patient and because the endoscope could not enter the acute angle of the anastomosis of the afferent limb in the other patient. Adverse events included jaundice (n = 1) and perforation (n = 1), which were successfully treated by conservative therapy.ERCP with BAE in patients with R-Y anastomosis and Whipple operation is safe and useful but has unique complications. The success rate is lower than that of conventional ERCP.

Citation

Jiheng Wang, Yuqi He, Dongliang Yu, Ge Gao, Lei Li. Endoscopic retrograde cholangiopancreatography with balloon-assisted enteroscopy in patients with Roux-en-Y anastomosis and Whipple operation. Medicine. 2020 Oct 16;99(42):e22653

Mesh Tags

PMID: 33080704

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