Mamoru Takenaka1, Kosuke Minaga2, Ken Kamata2, Kentaro Yamao2, Tomoe Yoshikawa2, Rei Ishikawa2, Ayana Okamoto2, Tomohiro Yamazaki2, Atsushi Nakai2, Shunsuke Omoto2, Yoriaki Komeda2, Toshiharu Sakurai2, Tomohiro Watanabe2, Naoshi Nishida2, Yasutaka Chiba3, Chang-Il Kwon4, Seok Jeong5, Tae Hoon Lee6, Masatoshi Kudo2. 1. Department of Gastroenterology and Hepatology, Faculty of Medicine, Kindai University, 377-2 Ohno-higashi, Osaka-Sayama, 589-8511, Japan. mamoxyo45@gmail.com. 2. Department of Gastroenterology and Hepatology, Faculty of Medicine, Kindai University, 377-2 Ohno-higashi, Osaka-Sayama, 589-8511, Japan. 3. Division of Biostatistics, Clinical Research Center, Faculty of Medicine, Kindai University, Osaka-Sayama, Japan. 4. Department of Gastroenterology, Digestive Disease Center, CHA Bundang Medical Center, CHA University, Seongnam, Korea. 5. Division of Gastroenterology, Department of Internal Medicine, Inha University School of Medicine, Incheon, Korea. 6. Division of Gastroenterology & Hepatology, Department of Internal Medicine, Soonchunhyang University College of Medicine, Cheonan Hospital, Cheonan, Korea.
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.
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.
Entities:
Keywords:
Balloon enteroscopy-assisted ERCP; ERCP; Patients with surgically altered gastrointestinal anatomy; The uneven method
Authors: Alberto Herreros de Tejada; Jose Luis Calleja; Gonzalo Díaz; Virginia Pertejo; Jesús Espinel; Guillermo Cacho; Javier Jiménez; Isabel Millán; Fernando García; Luis Abreu Journal: Gastrointest Endosc Date: 2009-06-27 Impact factor: 9.427
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