Single- and double-balloon enteroscopy-assisted endoscopic retrograde cholangiopancreatography in patients with Roux-en-Y plus hepaticojejunostomy anastomosis and Whipple resection

Dig Endosc. 2014 Apr;26 Suppl 2:136-43. doi: 10.1111/den.12254.


Background and aim: In patients with Roux-en-Y hepaticojejunostomy (HJ with R-Y) and Whipple resection, endoscopic retrograde cholangiopancreatography (ERCP) can be challenging. We report our experience with ERCP using balloon-assisted enteroscopy (BAE) (BAE-ERCP) in patients with HJ with R-Y, and Whipple resection.

Methods: BAE-ERCP procedures were carried out in 62 patients (HJ with R-Y:Whipple resection=34:28).

Results: Overall, the rates of reaching the anastomosis were 85.3% (29/34) in HJ with R-Y and 96.4% (27/28) in Whipple resection. In terms of HJ with R-Y, insertion success rate by standard single-balloon enteroscopy (SBE) was 89.3% (25/28). Insertion success rate by short BAE, including SBE and double-balloon enteroscopy (DBE), was 50% (3/6). There was a statistically significant difference of insertion success rate between standard long BE and short BE (P=0.021). However, in the Whipple patients, insertion success rate by standard and short SBE was 93.8% (15/16) and 91.7% (11/12), respectively. Initial insertion success rate by short BAE in Whipple patients was significantly higher than in HJ with R-Y (91.7% vs 50%, P=0.045). Therapeutic interventions included dilation of anastomosis stricture, stone extraction, endoscopic mechanical lithotripsy, biliary stent placement, stent extraction, endoscopic nasobiliary drainage, direct cholangioscopy, and electrohydraulic lithotripsy. Our HJ with R-Y series and Whipple series treatment success rate was 90% (18/20) and 95.0% (19/20), respectively.

Conclusions: BAE-ERCP enabled ERCP to be carried out in patients with HJ. It is considered safe and feasible. Further experience and device improvement are needed.

Keywords: Roux-en-Y; balloon-assisted enteroscopy; endoscopic retrograde cholangiopancreatography (ERCP); hepaticojejunostomy; single-balloon enteroscopy.

Publication types

  • Comparative Study

MeSH terms

  • Adolescent
  • Adult
  • Aged
  • Aged, 80 and over
  • Anastomosis, Roux-en-Y / methods
  • Anastomosis, Surgical / methods
  • Child
  • Cholangiopancreatography, Endoscopic Retrograde / methods*
  • Cohort Studies
  • Double-Balloon Enteroscopy / instrumentation*
  • Double-Balloon Enteroscopy / methods
  • Endoscopes, Gastrointestinal
  • Female
  • Follow-Up Studies
  • Gastrectomy / methods
  • Humans
  • Liver / surgery*
  • Male
  • Middle Aged
  • Pancreatectomy / methods*
  • Patient Safety
  • Postoperative Complications / epidemiology
  • Postoperative Complications / physiopathology
  • Reoperation
  • Retrospective Studies
  • Risk Assessment
  • Treatment Outcome
  • Young Adult