Authors (including presenting author) :
Cheng KS(1), Li KKM(1), Yip WM(2)
Affiliation :
(1)Department of Medicine and Geriatrics, Tuen Mun Hospital
(2)Department of Medicine and Geriatrics, Pok Oi Hospital
Introduction :
Double-balloon enteroscopy (DBE)-assisted ERCP has become a popular treatment option for biliary diseases in patients with surgically altered anatomy in recent years. However, this advanced endoscopy technique is rarely performed in Hospital Authority (HA).
Objectives :
To illustrate the efficacy and safety profile of DBE-assisted ERCP in patients with surgically altered anatomy
Methodology :
A retrospective study was conducted by reviewing the endoscopy outcomes of patients undergoing DBE-assisted ERCP for biliary diseases in Tuen Mun Hospital and Pok Oi Hospital from December 2015 to December 2020. In patients with Roux-en-Y reconstruction, DBE-assisted ERCP would be performed directly while in patients with other types of reconstruction, this procedure would only be considered after failed ERCP attempt by conventional endoscope, like duodenoscope or gastroscope. A short-type DBE system was used in all cases (EI-580BT enteroscope and TS-13101 overtube; FUJIFILM).
Result & Outcome :
46 DBE-assisted ERCP procedures had been performed in 37 patients, with mean age of 70.8 +/- 15.6 years old (range 29-100). Patients with different types of reconstruction surgery were included: Billroth II gastrectomy in 15 patients (40.5%), Roux-en-Y gastrectomy in 10 patients (27%), Roux-en-Y hepaticojejunostomy in 5 patients (13.5%), pancreatico-duodenectomy in 6 patients (16.2%) and Kasai Operation in 1 patient (2.7%). The enteroscopy success rate, defined as reaching the papilla or bilio-enteric anastomosis, was 95.8% (95% confidence interval (CI): 85.2%-99.5%), which was significantly lower in patients with intact stomach when compared with patients with prior gastrectomy (67% versus 100%, p=0.014). The diagnostic ERCP success rate, defined as performance of informative cholangiogram, was 84.1% (95% CI: 69.9%-93.4%) in attempted cases. Intended therapeutic interventions were successfully performed in 76.1% (95% CI: 61.2%-87.4%) of all procedures, including mechanical lithotripsy and extraction of biliary stones, sphincterotomy/ sphincteroplasty, stricture dilatation and placement of plastic/ metallic stent(s). Mean procedure time was 115.8 +/- 49.5 minutes (range 40-275). Adverse events were reported in 6 patients (13%) (95% CI: 4.9%-26.3%), including micro-perforation of intestine in 2 patients with prior Roux-en-Y gastrectomy (4.3%), 3 cases of acute cholangitis (6.5%) and 1 case of acute pancreatitis (2.2%). All events were managed successfully by conservative methods except a case of micro-perforation, which required laparotomy.
Conclusions: DBE-assisted ERCP is a promising technique to treat biliary disease in patient with surgically altered anatomy. This endoscopy technique should be promoted in HA.
