Double-balloon-enteroscopy-based endoscopic retrograde cholangiopancreatography in post-surgical patients

World J Gastroenterol. 2011 May 14;17(18):2302-14. doi: 10.3748/wjg.v17.i18.2302.


Aim: To evaluate double balloon enteroscopy (DBE) in post-surgical patients to perform endoscopic retrograde cholangiopancreatography (ERCP) and interventions.

Methods: In 37 post-surgical patients, a stepwise approach was performed to reach normal papilla or enteral anastomoses of the biliary tract/pancreas. When conventional endoscopy failed, DBE-based ERCP was performed and standard parameters for DBE, ERCP and interventions were recorded.

Results: Push-enteroscopy (overall, 16 procedures) reached enteral anastomoses only in six out of 37 post-surgical patients (16.2%). DBE achieved a high rate of luminal access to the biliary tract in 23 of the remaining 31 patients (74.1%) and to the pancreatic duct (three patients). Among all DBE-based ERCPs (86 procedures), 21/23 patients (91.3%) were successfully treated. Interventions included ostium incision or papillotomy in 6/23 (26%) and 7/23 patients (30.4%), respectively. Biliary endoprosthesis insertion and regular exchange was achieved in 17/23 (73.9%) and 7/23 patients (30.4%), respectively. Furthermore, bile duct stone extraction as well as ostium and papillary dilation were performed in 5/23 (21.7%) and 3/23 patients (13.0%), respectively. Complications during DBE-based procedures were bleeding (1.1%), perforation (2.3%) and pancreatitis (2.3%), and minor complications occurred in up to 19.1%.

Conclusion: The appropriate use of DBE yields a high rate of luminal access to papilla or enteral anastomoses in more than two-thirds of post-surgical patients, allowing important successful endoscopic therapeutic interventions.

Keywords: Choledochojejunostomy; Double balloon enteroscopy; Endoscopic retrograde cholangiopancreatography; Hepaticojejunostomy; Pancreaticojejunostomy; Percutaneous cholangiodrainage.

MeSH terms

  • Adult
  • Aged
  • Aged, 80 and over
  • Ampulla of Vater / surgery*
  • Anastomosis, Roux-en-Y*
  • Cholangiopancreatography, Endoscopic Retrograde*
  • Common Bile Duct Diseases / surgery*
  • Double-Balloon Enteroscopy*
  • Female
  • Humans
  • Liver / surgery*
  • Male
  • Middle Aged
  • Pancreas / surgery
  • Postoperative Complications
  • Prospective Studies