Endoscopic retrograde cholangiopancreatography by double-balloon enteroscopy in patients with surgically altered gastrointestinal anatomy

• Luis Eduardo Zamora Nava ^[1] ; Santiago Mier y Terán-Ellis ^[1] ; Sergio Zepeda Gómez ^[2] ; Enrique Pérez-Cuadrado Robles ^[5] ; América Liliana Miranda Lora ^[3] ; Francisco Valdovinos Andraca ^[1] ; Diana Paola López Méndez ^[4]
  1. [1] Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán

     Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán

     México

     
  2. [2] University of Alberta

     University of Alberta

     Canadá

     
  3. [3] Hospital Infantil de México Federico Gómez

     Hospital Infantil de México Federico Gómez

     México

     
  4. [4] Universidad Popular Autónoma del Estado de Puebla

     Universidad Popular Autónoma del Estado de Puebla

     México

     
  5. [5] Georges-Pompidou European Hospital. Paris, France

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• Localización: Revista Española de Enfermedades Digestivas, ISSN-e 2340-4167, ISSN 1130-0108, Vol. 112, Nº. 4, 2020, págs. 278-283
• Idioma: inglés
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  • Background: Endoscopic retrograde cholangiopancreatography (ERCP) allows a diagnostic and therapeutic evaluation of pancreatobiliary diseases. However, the procedure in patients with surgically altered gastrointestinal anatomy represents a technical challenge. Objective: to report the diagnostic and therapeutic outcome of device-assisted enteroscopy (DAE) ERCP in patients with a surgically altered gastrointestinal anatomy. Methods: a prospective cohort of patients with a history of surgically altered gastrointestinal anatomy undergoing DAE-ERCP in a referral center was used. A double-balloon enteroscope was used to reach the papillary area or the bilio-enteric anastomosis. The clinical and endoscopic characteristics, and technical, diagnostic and therapeutic success were described. Clinical and endoscopic differences were evaluated according to diagnostic success, as well as the biochemical response in those patients with therapeutic success. Results: ninety-six procedures were included in the study in 75 patients. Roux-en-Y hepaticojejunostomy (RYHJ) was the main surgical anatomy (82.3%) and cholangitis was the main indication for ERCP (49%). Diagnostic success was obtained in 69.8% of the participants. Of these, therapeutic success was obtained in 83.6% (overall success 58.3%). Cases with a diagnostic success had a higher frequency of cholangiography compared to those without diagnostic success (94% vs 0%, p < 0.001), as well as a lower probability of a failed cannulation (1.5% vs 100%, p < 0.001). A significant improvement was observed in patients with a therapeutic success in bilirubin, transaminases and alkaline phosphatase levels (p < 0.05). Conclusions: ERCP by means of double-balloon enteroscopy is a useful technique in patients with a surgically altered gastrointestinal anatomy, in whom access to the bile duct is required. However, these procedures are very challenging and diagnostic and therapeutic success where achieved in up to 60% of cases.