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, 25 (36), 5505-5514

Application of Single Balloon Enteroscopy-Assisted Therapeutic Endoscopic Retrograde Cholangiopancreatography in Patients After Bilioenteric Roux-en-Y Anastomosis: Experience of Multi-Disciplinary Collaboration

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Application of Single Balloon Enteroscopy-Assisted Therapeutic Endoscopic Retrograde Cholangiopancreatography in Patients After Bilioenteric Roux-en-Y Anastomosis: Experience of Multi-Disciplinary Collaboration

Wen-Guang Wu et al. World J Gastroenterol.

Abstract

Background: Bilioenteric Roux-en-Y anastomosis is one of the most complicated approaches for reconstructing the gastrointestinal tract, and endoscopic retrograde cholangiopancreatography (ERCP) is technically challenging in patients after bilioenteric Roux-en-Y anastomosis. The optimal endoscopic strategies for such cases remain unknown.

Aim: To explore the feasibility and effectiveness of single balloon enteroscopy-assisted (SBE-assisted) therapeutic ERCP in patients after bilioenteric Roux-en-Y anastomosis based on multi-disciplinary collaboration between endoscopists and surgeons as well as report the experience from China.

Methods: This is a single center retrospective study. All of the SBE-assisted therapeutic ERCP procedures were performed by the collaboration between endoscopists and surgeons. The operation time, success rate, and complication rate were calculated.

Results: Forty-six patients received a total of 64 SBE-assisted therapeutic ERCP procedures, with successful scope intubation in 60 (93.8%) cases and successful diagnosis in 59 (92.2%). All successfully diagnosed cases received successful therapy. None of the cases had perforation or bleeding during or after operation, and no post-ERCP pancreatitis occurred.

Conclusion: Based on multi-disciplinary collaboration, SBE-assisted therapeutic ERCP in patients after bilioenteric Roux-en-Y anastomosis is relatively safe and effective and has a high success rate.

Keywords: Bilioenteric Roux-en-Y anastomosis; Hepaticojejunostomy; Multi-disciplinary cooperation; Pancreaticoduodenectomy; Single balloon enteroscopy.

Conflict of interest statement

Conflict-of-interest statement: The authors declare no conflict of interest. The authors declare that they have nothing to disclose.

Figures

Figure 1
Figure 1
The entire operation team, including the general surgeon (A), endoscopist (B), and nurse assistants (C).
Figure 2
Figure 2
Schema of the operation procedure. A: Billroth II gastroenterostomy and pancreatico-duodenectomy; B: Bilioenteric Roux-en-Y anastomosis and pancreatico-duodenectomy.
Figure 3
Figure 3
The operation procedure. A: The endoscopist collaborated with the nurse to inflate the scope and overtube as well as deflate and move the equipment, which were repeated to slowly advance the scope forward; B: Locating the bilioenteric Roux-en-Y anastomosis (Endoscopic view); C: Completion of the biliary duct cannulation and cholangiogram, revealing intrahepatic bile duct stones; D: Intrahepatic bile duct stones were extracted successfully; E: Operations such as stone extraction under direct visualization can be more accurate. Before completing the procedure, visualizing and confirming that the stones are all extracted and that there are no residual stones are possible; F: Large stones can also be extracted after holmium laser lithotripsy under SBE direct visualization; G: Bilioenteric Roux-en-Y anastomotic stricture was treated by balloon dilatation; H: Foreign body at the anastomotic site (endoscopic view); I: The foreign body was extracted successfully; J: Bilioenteric Roux-en-Y anastomosis malignant stenosis was treated by balloon dilatation and stenting; K: Successful endoscopic nasobiliary drainage via a single balloon enteroscope.

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