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

World Journal of Gastroenterology 2011年第18期17卷 2302-2314页

作者： Martin Raithel Harald Dormann Andreas Naegel Frank Boxberger Eckhart G Hahn Markus F Neurath Juergen Maiss Department of Medicine 1 University of Erlangen-Nürnberg Emergency Unit City Hospital Fürth Dean of the University Witten-Herdecke

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.

关键词： Double balloon enteroscopy Endoscopic retrograde cholangiopancreatography Choledochojejunostomy Hepaticojejunostomy Pancreaticojejunostomy percutaneous cholangiodrainage

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