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Efficacy of a modified double-guidewire technique using an uneven double lumen cannula (uneven method) in patients with surgically altered gastrointestinal anatomy (with video)

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Abstract
Background: Balloon enteroscopy-assisted endoscopic retrograde cholangiopancreatography (BE-ERCP) has been reported to be effective for patients with surgically altered gastrointestinal anatomy. However, selective biliary cannulation remains difficult in BE-ERCP. We examined the usefulness of a modified double-guidewire technique using an uneven double lumen cannula (the uneven method) for BE-ERCP in patients with surgically altered gastrointestinal anatomy.

Methods: To clarify the usefulness of the uneven method for selective biliary cannulation in BE-ERCP in comparison to the pancreatic guidewire (PGW) method, 40 patients with surgically altered gastrointestinal anatomy who underwent BE-ERCP with successful placement of a guidewire in the pancreatic duct were evaluated. The uneven method was used in 18 cases (uneven group) and the PGW method was used in the remaining 22 cases (PGW group).

Results: The technical success rate of biliary cannulation was higher in the uneven group than in the PGW group (83.3 vs. 59.0%; P = 0.165). In addition, the time to biliary cannulation were significantly shorter in the uneven group than in the PGW group (6 vs. 18 min; P = 0.004; respectively). In the PGW group, post-ERCP pancreatitis (PEP) occurred in 3 of 22 cases (13.6%). No adverse events, including PEP, occurred in the uneven group.

Conclusions: The uneven method may be a useful option of selective biliary cannulation in BE-ERCP for the patients with surgically altered gastrointestinal anatomy.
All Author(s)
M. Takenaka ; K. Minaga ; K. Kamata ; K. Yamao ; T. Yoshikawa ; R. Ishikawa ; A. Okamoto ; T. Yamazaki ; A. Nakai ; S. Omoto ; Y. Komeda ; T. Sakurai ; T. Watanabe ; N. Nishida ; Y. Chiba ; C. I. Kwon ; S. Jeong ; T. H. Lee ; M. Kudo
Issued Date
2020
Type
Article
Keyword
Balloon enteroscopy-assisted ERCPERCPPatients with surgically altered gastrointestinal anatomyThe uneven method
Publisher
Society of American Gastrointestinal Endoscopic Surgeons
European Association for Endoscopic Surgery
ISSN
0930-2794 ; 1432-2218
Citation Title
Surgical endoscopy
Citation Volume
34
Citation Number
3
Citation Start Page
1432
Citation End Page
1441
Language(ISO)
eng
DOI
10.1007/s00464-019-07228-5
URI
http://schca-ir.schmc.ac.kr/handle/2022.oak/2251
Appears in Collections:
소화기내과 > 1. Journal Papers
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