Retrospective Cohort Study
Copyright ©The Author(s) 2019. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Clin Cases. Jan 6, 2019; 7(1): 10-18
Published online Jan 6, 2019. doi: 10.12998/wjcc.v7.i1.10
Risk factors for perforation during endoscopic retrograde cholangiopancreatography in post-reconstruction intestinal tract
Shinichi Takano, Mitsuharu Fukasawa, Hiroko Shindo, Ei Takahashi, Sumio Hirose, Yoshimitsu Fukasawa, Satoshi Kawakami, Hiroshi Hayakawa, Hiroshi Yokomichi, Makoto Kadokura, Tadashi Sato, Nobuyuki Enomoto
Shinichi Takano, Mitsuharu Fukasawa, Hiroko Shindo, Ei Takahashi, Sumio Hirose, Yoshimitsu Fukasawa, Satoshi Kawakami, Hiroshi Hayakawa, Makoto Kadokura, Tadashi Sato, Nobuyuki Enomoto, First Department of Internal Medicine, Faculty of Medicine, University of Yamanashi, Yamanashi 409-3898, Japan
Hiroshi Yokomichi, Department of Health Sciences, Interdisciplinary Graduate School and Engineering, University of Yamanashi, Yamanashi 409-3898, Japan
Author contributions: Takano S designed and conducted the research and wrote the paper; Fukasawa M designed the research and supervised the report; Shindo H, Takahashi E, Hirose S, Fukasawa Y, Kawakami S, Hayakawa H, and Kadokura M provided clinical advice; Hiroshi Yokomichi checked statistical methods; Sato T and Enomoto N supervised the report.
Institutional review board statement: This retrospective study was approved by the ethics committee of Yamanashi University Hospital.
Informed consent statement: The requirement for written informed consent was waived by the ethics committee of our institution because the study was a retrospective data analysis. Appropriate consideration was given to patient risk, privacy, welfare, and rights.
Conflict-of-interest statement: All authors report no financial conflicts of interest related to this article.
Data sharing statement: No additional data are available.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Corresponding author: Mitsuharu Fukasawa, MD, PhD, Lecturer, First Department of Internal Medicine, Faculty of Medicine, University of Yamanashi, 1110, Shimokato, Chuo, Yamanashi 409-3898, Japan. fmitsu@yamanashi.ac.jp
Telephone: +81-55-273-9584 Fax: +81-55-273-6748
Received: October 27, 2018
Peer-review started: October 29, 2018
First decision: November 22, 2018
Revised: December 16, 2018
Accepted: December 21, 2018
Article in press: December 21, 2018
Published online: January 6, 2019
Abstract
BACKGROUND

Endoscopic retrograde cholangiopancreatography (ERCP) in patients with surgically altered anatomy has been a major challenge to gastrointestinal endoscopists with low success rates for reaching the target site as well as high complication rates. The knowledge of ERCP-related risk factors is important for reducing unexpected complications.

AIM

To identify ERCP-related risk factors for perforation in patients with surgically altered anatomy.

METHODS

The medical records of 187 patients with surgically altered anatomy who underwent ERCP at our institution between April 2009 and December 2017 were retrospectively reviewed. An analysis of patient data, including age, sex, type of reconstruction, cause of surgery, aim of ERCP, success rate of reaching target site, success rate of procedure, adverse events, type of scope, time to reach the target site, and duration of procedure, was performed. In patients with Billroth-II reconstruction, additional potential risk factors were the shape of the inserted scope and whether the anastomosis was antecolic or retrocolic.

RESULTS

All patients (n = 187) had surgical anatomy, such as Billroth-I (n = 22), Billroth-II (n = 33), Roux-en-Y (n = 54), Child, or Whipple reconstruction (n = 75). ERCP was performed for biliary drainage in 43 cases (23%), stone removal in 29 cases (16%), and stricture dilation of anastomosis in 59 cases (32%). The scope was unable to reach the target site in 17 cases (9%), and an aimed procedure could not be accomplished in 54 cases (29%). Adverse events were pancreatitis (3%), hyperamylasemia (10%), cholangitis (6%), cholestasis (4%), excessive sedation (1%), perforation (2%), and others (3%). Perforation occurred in three cases, all of which were in patients with Billroth-II reconstruction; in these patients, further analysis revealed loop-shaped insertion of the scope to be a significant risk for perforation (P = 0.01).

CONCLUSION

Risk factors for perforation during ERCP in patients with surgically altered anatomy were Billroth-II reconstruction and looping of the scope during Billroth-II procedure.

Keywords: Surgically altered anatomy, Billroth-II, Endoscopic retrograde cholangiopancreatography, Perforation

Core tip: Endoscopic retrograde cholangiopancreatography (ERCP) for patients with surgically altered anatomy accompanies a high risk of perforation. This study identified that Billroth-II reconstruction was associated with high risk of perforation during ERCP procedure. Moreover, a looping shape of a scope during insertion in patients with Billroth-II reconstruction proved to be a more specific risk factor of perforation in ERCP.