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
ARTICLE HIGHLIGHTS
Research background

The development of deep enteroscopies, such as double-balloon enteroscopy (DBE) and single-balloon enteroscopy has enabled performing endoscopic retrograde cholangiopancreatography (ERCP) in patients with surgically altered anatomy, such as Billroth-II and Roux-en-Y reconstructions.

Research motivation

Surgically altered anatomy is a risk factor for perforations, not only in ERCP-related procedures, but also in DBE-related procedures. However, no report has elucidated the risk factors for perforation by type of surgical anatomy and detailed operative information.

Research objectives

The main objective of this study is to identify ERCP-related risk factors for perforation in patients with surgically altered anatomy.

Research methods

Medical records of 187 patients with surgically altered anatomy who underwent ERCP at our institution between April 2009 and December 2017 were retrospectively reviewed and analyzed to identify risk factors for perforation.

Research results

All patients who had undergone perforation were with Billroth-II reconstruction; further analysis in these patients revealed loop-shaped insertion of the scope to be a significant risk for perforation.

Research conclusions

The new findings of this study are that 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.

Research perspectives

Our findings suggest that, in patients with Billroth-II reconstruction, reaching the target site with the scope in a loop configuration carried a risk of perforation; therefore, it should be performed carefully.