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Efficacy and factors affecting procedure results of short-type single-balloon enteroscopy–assisted ERCP for altered anatomy: a multicenter cohort in Japan

Published:September 14, 2021DOI:https://doi.org/10.1016/j.gie.2021.09.008

      Background and Aims

      Although single-balloon enteroscopy (SBE)-assisted or short-type SBE (short SBE)-assisted ERCP has been reported as useful in patients with surgically altered anatomy, most studies had small sample sizes or single-center designs. This study aimed to evaluate the efficacy and factors affecting the procedure results of short SBE–assisted ERCP in patients with surgically altered anatomy.

      Methods

      This multicenter, retrospective study was conducted at 8 tertiary referral care centers in Japan. The data of patients who underwent ERCP-related procedures using short SBE between September 2011 and August 2019 at each facility were analyzed.

      Results

      Overall, 1318 patients were included in this analysis. The enteroscopy (reaching the target site), cannulation, and total procedural success rates were 87.9% (95% confidence interval [CI], 86.1%-89.6%), 87.0% (95% CI, 84.9%-88.8%), and 74.9% (95% CI, 72.5%-77.2%), respectively. Adverse events occurred in 7.7% of patients (95% CI, 6.4%-9.3%). Multiple logistic regression analysis indicated that age (≥75 years), Roux-en-Y reconstruction, pancreatic indication, and malignancy were factors affecting the total procedural failure.

      Conclusions

      This large-scale study proved that short SBE–assisted ERCP in patients with surgically altered anatomy was effective. Moreover, it clarified factors affecting procedure results. Proficiency with alternative treatment techniques is required in difficult cases. (Clinical trial registration number: UMIN00004045.)

      Abbreviations:

      AOR (adjusted odds ratio), CI (confidence interval), EUS-BD/PD (EUS-guided biliary/pancreatic drainage), PTBD (percutaneous transhepatic biliary drainage), SBE (single-balloon enteroscopy), short SBE (short-type single-balloon enteroscopy)
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      References

        • Freeman M.L.
        • Guda N.M.
        ERCP cannulation: a review of reported techniques.
        Gastrointest Endosc. 2005; 61: 112-115
        • Suisse A.
        • Yassin K.
        • Lavy A.
        • et al.
        Outcome and early complications of ERCP: a prospective single center study.
        Hepatogastroenterology. 2005; 52: 352-355
        • Elton E.
        • Hanson B.L.
        • Qaseem T.
        • et al.
        Diagnostic therapeutic ERCP using an enteroscope and pediatric colonoscope in long-limb surgical bypass patients.
        Gastrointest Endosc. 1998; 47: 62-67
        • Wright B.E.
        • Cass O.W.
        • Freeman M.L.
        ERCP in patients with long-limb Roux-en-Y gastrojejunostomy and intact papilla.
        Gastrointest Endosc. 2002; 56: 225-232
        • Yamamoto H.
        • Sekine Y.
        • Sato Y.
        • et al.
        Total enteroscopy with a nonsurgical steerable double-balloon method.
        Gastrointest Endosc. 2001; 53: 216-220
        • Wang A.Y.
        • Sauer B.G.
        • Behm B.W.
        • et al.
        Single-balloon enteroscopy effectively enables diagnostic and therapeutic retrograde cholangiography in patients with surgically altered anatomy.
        Gastrointest Endosc. 2010; 71: 641-649
        • Azeem N.
        • Tabibian J.H.
        • Baron T.H.
        • et al.
        Use of a single-balloon enteroscope compared with variable-stiffness colonoscopes for endoscopic retrograde cholangiography in liver transplant patients with Roux-en-Y biliary anastomosis.
        Gastrointest Endosc. 2013; 77: 568-577
        • Tomizawa Y.
        • Sullivan C.T.
        • Gelrud A.
        Single balloon enteroscopy (SBE) assisted therapeutic endoscopic retrograde cholangiopancreatography (ERCP) in patients with Roux-en-Y anastomosis.
        Dig Dis Sci. 2014; 59: 465-470
        • Tanisaka Y.
        • Ryozawa S.
        • Mizuide M.
        • et al.
        Status of single-balloon enteroscopy-assisted endoscopic retrograde cholangiopancreatography in patients with surgically altered anatomy: systematic review and meta-analysis on biliary interventions.
        Dig Endosc. Epub. 2020; (Oct 18)
        • Kawamura T.
        • Uno K.
        • Suzuki A.
        • et al.
        Clinical usefulness of a short-type, prototype single-balloon enteroscope for endoscopic retrograde cholangiopancreatography in patients with altered gastrointestinal anatomy: preliminary experiences.
        Dig Endosc. 2015; 27: 82-86
        • Yamauchi H.
        • Kida M.
        • Okuwaki K.
        • et al.
        Passive-bending, short-type single-balloon enteroscope for endoscopic retrograde cholangiopancreatography in Roux-en-Y anastomosis patients.
        World J Gastroenterol. 2015; 21: 1546-1553
        • Ishii K.
        • Itoi T.
        • Tonozuka R.
        • et al.
        Balloon enteroscopy-assisted ERCP in patients with Roux-en-Y gastrectomy and intact papillae (with videos).
        Gastrointest Endosc. 2016; 83: 377-386
        • Yane K.
        • Katanuma A.
        • Maguchi H.
        • et al.
        Short-type singleballoon enteroscope-assisted ERCP in postsurgical altered anatomy: potential factors affecting procedural failure.
        Endoscopy. 2017; 49: 69-74
        • Tanisaka Y.
        • Ryozawa S.
        • Mizuide M.
        • et al.
        Analysis of the factors involved in procedural failure: endoscopic retrograde cholangiopancreatography using a short-type single-balloon enteroscope for patients with surgically altered gastrointestinal anatomy.
        Dig Endosc. 2019; 31: 682-689
        • Tanisaka Y.
        • Ryozawa S.
        • Mizuide M.
        • et al.
        Usefulness of the “newly designed” short-type single-balloon enteroscope for ERCP in patients with Roux-en-Y gastrectomy: a pilot study.
        Endosc Int Open. 2018; 6: E1417-E1422
        • Park C.H.
        • Lee W.S.
        • Joo Y.E.
        • et al.
        Cap-assisted ERCP in patients with a Billroth II gastrectomy.
        Gastrointest Endosc. 2007; 66: 612-615
        • Trindade A.J.
        • Mella J.M.
        • Slattery E.
        • et al.
        Use of a cap in single-balloon enteroscopy-assisted endoscopic retrograde cholangiography.
        Endoscopy. 2015; 47: 453-456
        • Cotton P.B.
        • Eisen G.M.
        • Aabakken L.
        • et al.
        A lexicon for endoscopic adverse events: report of an ASGE workshop.
        Gastrointest Endosc. 2010; 71: 446-454
        • Tønnesen C.J.
        • Young J.
        • Glomsaker T.
        • et al.
        Laparoscopy-assisted versus balloon enteroscopy-assisted ERCP after Roux-en-Y gastric bypass.
        Endoscopy. 2020; 52: 654-661
        • Layec S.
        • D’Halluin P.-N.
        • Pagenault M.
        • et al.
        Removal of transanastomotic pancreatic stent tubes after pancreaticoduodenectomy: a new role for double-balloon enteroscopy.
        Gastrointest Endosc. 2010; 72: 449-451
        • Menon K.V.N.
        • Sanaka M.
        Successful single-balloon enteroscopic dilation of late anastomotic pancreaticojejunostomy stricture following Whipple procedure.
        Pancreas. 2010; 39: 115-116
        • Park J.-H.
        • Ye B.D.
        • Byeon J.-S.
        • et al.
        Approaching pancreatic duct through pancreaticojejunostomy site with double ballon enteroscope in patients with Roux-en-Y anatomy.
        Hepatogastroenterology. 2013; 60: 1753-1758
        • Kogure H.
        • Sato T.
        • Nakai Y.
        • et al.
        Endoscopic management of pancreatic diseases in patients with surgically altered anatomy: clinical outcomes of combination of double-balloon endoscopy- and endoscopic ultrasound-guided interventions.
        Dig Endosc. 2021; 33: 441-450
        • James T.W.
        • Fan Y.C.
        • Baron T.H.
        EUS-guided hepaticoenterostomy as a portal to allow definitive antegrade treatment of benign biliary diseases in patients with surgically altered anatomy.
        Gastrointest Endosc. 2018; 88: 547-554
        • Mukai S.
        • Itoi T.
        • Sofuni A.
        • et al.
        EUS-guided antegrade intervention for benign biliary diseases in patients with surgically altered anatomy (with videos).
        Gastrointest Endosc. 2019; 89: 399-407
        • Fujii L.L.
        • Topazian M.D.
        • Abu Dayyeh B.K.
        • et al.
        EUS-guided pancreatic duct intervention: outcomes of a single tertiary-care referral center experience.
        Gastrointest Endosc. 2013; 78: 854-864
        • Tyberg A.
        • Sharaiha R.Z.
        • Kedia P.
        • et al.
        EUS-guided pancreatic drainage for pancreatic strictures after failed ERCP: a multicenter international collaborative study.
        Gastrointest Endosc. 2017; 85: 164-169
        • Weilert F.
        • Binmoeller K.F.
        • Marson F.
        • et al.
        Endoscopic ultrasound-guided anterograde treatment of biliary stones following gastric bypass.
        Endoscopy. 2011; 43: 1105-1108
        • Shimatani M.
        • Hatanaka H.
        • Kogure H.
        • et al.
        Diagnostic and therapeutic endoscopic retrograde cholangiography using a short-type double-balloon endoscope in patients with altered gastrointestinal anatomy: a multicenter prospective study in Japan.
        Am J Gastroenterol. 2016; 111: 1750-1758