Original Article
Copyright ©2011 Baishideng Publishing Group Co., Limited. All rights reserved.
World J Gastroenterol. May 14, 2011; 17(18): 2302-2314
Published online May 14, 2011. doi: 10.3748/wjg.v17.i18.2302
Double-balloon-enteroscopy-based endoscopic retrograde cholangiopancreatography in post-surgical patients
Martin Raithel, Harald Dormann, Andreas Naegel, Frank Boxberger, Eckhart G Hahn, Markus F Neurath, Juergen Maiss
Martin Raithel, Andreas Naegel, Frank Boxberger, Markus F Neurath, Department of Medicine 1, University of Erlangen-Nürnberg, Ulmenweg 18, 91054 Erlangen, Germany
Harald Dormann, Emergency Unit, City Hospital Fürth, Jakob-Henle-Str. 1, 9077966 Fürth, Germany
Harald Dormann, Eckhart G Hahn, Department of Medicine 1, University of Erlangen-Nürnberg, Ulmenweg 18, 91054 Erlangen, Germany
Eckhart G Hahn, Dean of the University Witten-Herdecke, Alfred-Herrhausen-Str. 50, 58448 Witten, Germany
Juergen Maiss, Gastroenterology Clinic Dr. Kerzel/PD Dr. Maiss, Mozartstr. 1, D-91301 Forchheim, Germany, Department of Medicine 1, University of Erlangen-Nürnberg, Ulmenweg 18, 91054 Erlangen, Germany
Author contributions: Raithel M and Maiss J: Manuscript preparation, study design, data analysis, patients examination; Dormann H, Naegel A and Boxberger F: data collection and examination; Hahn EG and Neurath MF: corrected the paper.
Correspondence to: Martin Raithel, MD, Professor of Medicine, Departement of Medicine 1, Gastroenterology, Functional Tissue Diagnostics, University Erlangen-Nuremberg, Ulmenweg 18, 91054, Erlangen, Germany. martin.raithel@uk-erlangen.de
Telephone: +49-9131-8535151 Fax: +49-9131-8535152
Received: June 20, 2010
Revised: September 26, 2010
Accepted: October 3, 2010
Published online: May 14, 2011

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.

Keywords: Double balloon enteroscopy, Endoscopic retrograde cholangiopancreatography, Choledochojejunostomy, Hepaticojejunostomy, Pancreaticojejunostomy, Percutaneous cholangiodrainage