Published online Jan 6, 2019. doi: 10.12998/wjcc.v7.i1.10
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
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.
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.
The main objective of this study is to identify ERCP-related risk factors for perforation in patients with surgically altered anatomy.
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.
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.
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.
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.