Brief Article
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World J Gastroenterol. Nov 28, 2013; 19(44): 8047-8055
Published online Nov 28, 2013. doi: 10.3748/wjg.v19.i44.8047
Single balloon enteroscopy for endoscopic retrograde cholangiography in patients with Roux-en-Y hepaticojejunoanastomosis
Bohuslav Kianička, Jan Lata, Ivo Novotný, Petr Dítě, Jiří Vaníček
Bohuslav Kianička, 2nd Clinic of Internal Medicine, Department of Gastroenterology, St. Anne’s University Hospital Brno, 656 91 Brno, Czech Republic
Jan Lata, University of Ostrava, Faculty of Medicine, 703 00 Ostrava, Czech Republic
Ivo Novotný, Department of Gastroenterology, Masaryk Memorial Cancer Institute, 602 00 Brno, Czech Republic
Petr Dítě, Academic Centre of Digestive Oncology, Faculty of Medicine, University of Ostrava, 703 00 Ostrava, Czech Republic
Jiří Vaníček, Department of Diagnostic Imaging and International Clinical Research Center (ICRC), St. Anne’s University Hospital Brno, 656 91 Brno, Czech Republic
Author contributions: Kianička B, Lata J and Novotný I contributed equally to this work; Kianička B, Lata J, Dítě P and Vaníček J designed the study; Kianička B, Lata J, Novotný I, Dítě P and Vaníček J performed the study; Lata J analyzed the data; Kianička B and Novotný I wrote the manuscript; Lata J and Dítě P revised the manuscript.
Correspondence to: Bohuslav Kianička, MD, PhD, 2nd Clinic of Internal Medicine, Department of Gastroenterology, St. Anne’s University Hospital Brno, Pekarska 53, 656 91 Brno, Czech Republic. bohuslav.kianicka@fnusa.cz
Telephone: +420-60-4946828 Fax: +420-54-3182307
Received: February 22, 2013
Revised: August 26, 2013
Accepted: September 3, 2013
Published online: November 28, 2013
Processing time: 291 Days and 22.1 Hours
Abstract

AIM: To evaluate single balloon enteroscopy in diagnostic and therapeutic endoscopic retrograde cholangiography (ERC) in patients with Roux-en-Y hepaticojejunoanastomosis (HJA).

METHODS: The study took place from January 2009 to December 2011 and we retrospectively assessed 15 patients with Roux-en-Y HJA who had signs of biliary obstruction. In total, 23 ERC procedures were performed in these patients and a single balloon videoenteroscope (Olympus SIF Q 180) was used in all of the cases. A transparent overtube was drawn over the videoenteroscope and it freely moved on the working part of the enteroscope. Its distal end was equipped with a silicone balloon that was inflated by air from an external pump at a pressure of ≤ 5.4 kPa. The technical limitations or rather the parameters of the single balloon enteroscope (working length - 200 cm, diameter of the working channel - 2.8 mm, absence of Albarran bridge) showed the need for special endoscopic instrumentation.

RESULTS: Cannulation success was reached in diagnostic ERC in 12 of 15 patients. ERC findings were normal in 1 of 12 patients. ERC in the remaining 11 patients showed some pathological changes. One of these (cystic bile duct dilation) was subsequently resolved surgically. Endoscopic treatment was initialized in the remaining 10 patients (5 with HJA stenosis, 2 with choledocholithiasis, and 3 with both). This treatment was successful in 9 of 10 patients. The endoscopic therapeutic procedures included: balloon dilatation of HJA stenosis - 11 times (7 patients); choledocholitiasis extraction - five times (5 patients); biliary plastic stent placement - six times (4 patients); and removal of biliary stents placed by us - six times (4 patients). The mean time of performing a single ERC was 72 min. The longest procedure took 110 min and the shortest took 34 min. This shows that it is necessary to allow for more time in individual procedures. Furthermore, these procedures require the presence of an anesthesiologist. We did not observe any complications in these 15 patients.

CONCLUSION: This method is more demanding than standard endoscopic retrograde cholangiopancreatography due to altered postsurgical anatomy. However, it is effective, safe, and widens the possibilities of resolving biliary pathology.

Keywords: Single balloon enteroscopy; Endoscopic retrograde cholangiography; Roux-Y hepaticojejunoanastomosis; Endoscopic diagnosis; Endoscopic treatment

Core tip: Endoscopic retrograde cholangiopancreatography (ERCP) represents a demanding method even in a normal anatomical situation. When a surgically altered gastrointestinal or pancreatobiliary anatomy is present, ERCP becomes even more demanding. Our retrospective study assessed diagnostic and therapeutic endoscopic retrograde cholangiography (ERC) using a single balloon enteroscope in 15 patients with Roux-en-Y hepaticojejunoanastomosis. A comparatively high success rate was achieved in both diagnostic (80%) and therapeutic (90%) ERC. This method is both time-consuming and technically demanding. However, it is an effective and safe method that widens the possibilities of resolving biliary pathology in these conditions.