Double-balloon enteroscopy for ERCP in patients with Billroth II anatomy: results of a large series of papillary large-balloon dilation for biliary stone removal

Background and study aims: Data on double-balloon enteroscopy (DBE)-assisted endoscopic retrograde cholangiopancreatogrphy (ERCP) in patients with Billroth II gastrectomy and the use of endoscopic papillary large-balloon dilation (EPLBD) for the removal of common bile duct stones in Billroth II anatomy are limited. The aims of the study were to evaluate the success of DBE-assisted ERCP in patients with Billroth II gastrectomy and examine the efficacy of EPLBD ( ≥ 10 mm) for the removal of common bile duct stones. Patients and methods: A total of 77 patients with Billroth II gastrectomy in whom standard ERCP had failed underwent DBE-assisted ERCP. DBE success was defined as visualizing the papilla and ERCP success as completing the intended intervention. The clinical results of EPLBD for the removal of common bile duct stones were analyzed. Results: DBE was successful in 73 of 77 patients (95 %), and ERCP success was achieved in 67 of these 73 (92 %). Therefore, the rate of successful DBE-assisted ERCP was 87 % (67 of a total of 77 patients). The reasons for ERCP failure (n = 10) included tumor obstruction (n = 2), adhesion obstruction (n = 2), failed cannulation (n = 3), failed stone removal (n = 2), and bowel perforation (n = 1). Overall DBE-assisted ERCP complications occurred in 5 of 77 patients (6.5 %). A total of 48 patients (34 male, mean age 75.5 years) with common bile duct stones underwent EPLBD. Complete stone removal in the first session was accomplished in 36 patients (75 %); mechanical lithotripsy was required in 1 patient. EPLBD-related mild perforation occurred in 2 patients (4 %). No acute pancreatitis occurred. Conclusions: DBE permits therapeutic ERCP in patients who have a difficult Billroth II gastrectomy with a high success rate and acceptable complication rates. EPLBD is effective and safe for the removal of common bile duct stones in patients with Billroth II anatomy.

[1]  Matthew J. Skinner,et al.  ERCP with the overtube-assisted enteroscopy technique: a systematic review , 2014, Endoscopy.

[2]  N. Sasahira,et al.  Short- and long-term outcomes of endoscopic papillary large balloon dilation with or without sphincterotomy for removal of large bile duct stones , 2013, Scandinavian journal of gastroenterology.

[3]  J. Hwang,et al.  Endoscopic papillary large balloon dilation for the removal of bile duct stones. , 2013, World journal of gastroenterology.

[4]  D. Morgan,et al.  A multicenter, U.S. experience of single-balloon, double-balloon, and rotational overtube-assisted enteroscopy ERCP in patients with surgically altered pancreaticobiliary anatomy (with video). , 2013, Gastrointestinal endoscopy.

[5]  F. Chan,et al.  Randomized trial of endoscopic sphincterotomy with balloon dilation versus endoscopic sphincterotomy alone for removal of bile duct stones. , 2013, Gastroenterology.

[6]  S. Shin,et al.  Endoscopic large-balloon dilation alone versus endoscopic sphincterotomy plus large-balloon dilation for the treatment of large bile duct stones , 2013, BMC Gastroenterology.

[7]  Kazuhiko Nakamura,et al.  Improved techniques for double-balloon-enteroscopy-assisted endoscopic retrograde cholangiopancreatography. , 2012, World journal of gastroenterology.

[8]  S. Baik,et al.  Usefulness of Forward-Viewing Endoscope for Endoscopic Retrograde Cholangiopancreatography in Patients with Billroth II Gastrectomy , 2012, Clinical endoscopy.

[9]  M. Oh,et al.  Prospective comparative study of endoscopic papillary large balloon dilation and endoscopic sphincterotomy for removal of large bile duct stones in patients above 45 years of age , 2012, Scandinavian journal of gastroenterology.

[10]  D. Kang,et al.  Endoscopic papillary large balloon dilation in Billroth II gastrectomy patients with bile duct stones , 2012, Journal of gastroenterology and hepatology.

[11]  H. Pan,et al.  Endoscopic papillary large balloon dilation alone without sphincterotomy for the treatment of large common bile duct stones , 2011, BMC gastroenterology.

[12]  N. Marcon,et al.  'Short' double-balloon enteroscope endoscopic retrograde cholangiopancreatography in patients with a surgically altered upper gastrointestinal tract. , 2011, Canadian journal of gastroenterology = Journal canadien de gastroenterologie.

[13]  Jui-Hsiang Tang,et al.  Double balloon endoscopy increases the ERCP success rate in patients with a history of Billroth II gastrectomy. , 2010, World journal of gastroenterology.

[14]  F. Itokawa,et al.  Single-Balloon Enteroscopy–Assisted ERCP in Patients With Billroth II Gastrectomy or Roux-en-Y Anastomosis (With Video) , 2010, The American Journal of Gastroenterology.

[15]  J. I. Lee,et al.  Endoscopic large-balloon sphincteroplasty without preceding sphincterotomy for the removal of large bile duct stones: a preliminary study. , 2009, Gastrointestinal endoscopy.

[16]  K. Uchida,et al.  Effective ”short” double-balloon enteroscope for diagnostic and therapeutic ERCP in patients with altered gastrointestinal anatomy: a large case series , 2009, Endoscopy.

[17]  F. Itokawa,et al.  Endoscopic Sphincterotomy Combined With Large Balloon Dilation Can Reduce the Procedure Time and Fluoroscopy Time for Removal of Large Bile Duct Stones , 2009, The American Journal of Gastroenterology.

[18]  M. Freeman,et al.  Large-diameter biliary orifice balloon dilation to aid in endoscopic bile duct stone removal: a multicenter series. , 2008, Gastrointestinal endoscopy.

[19]  E. Parlak,et al.  Endoscopic retrograde cholangiopancreatography in patients with Billroth II gastroenterostomy , 2007, Journal of gastroenterology and hepatology.

[20]  S. Lo,et al.  What is the learning curve associated with double-balloon enteroscopy? Technical details and early experience in 6 U.S. tertiary care centers. , 2006, Gastrointestinal endoscopy.

[21]  W. T. Young,et al.  Diagnostic and therapeutic endoscopic retrograde cholangiopancreaticography after Billroth II gastrectomy--safe provision in a district general hospital. , 2005, Annals of the Royal College of Surgeons of England.

[22]  M. E. Ryan,et al.  Endoscopic balloon dilation compared with sphincterotomy for extraction of bile duct stones. , 2004, Gastroenterology.

[23]  I. Yasuda,et al.  Endoscopic sphincterotomy and endoscopic papillary balloon dilatation for bile duct stones: A prospective randomized controlled multicenter trial. , 2003, Gastrointestinal endoscopy.

[24]  H. Moriwaki,et al.  Can endoscopic papillary balloon dilation really preserve sphincter of Oddi function? , 2001, Gut.

[25]  K. Sugano,et al.  Total enteroscopy with a nonsurgical steerable double-balloon method. , 2001, Gastrointestinal endoscopy.

[26]  J. Lau,et al.  Small-Bowel Perforations Related to Endoscopic Retrograde Cholangiopancreatography (ERCP) in Patients with Billroth II Gastrectomy , 1999, Endoscopy.

[27]  Lien‐Fu Lin,et al.  ERCP in post-Billroth II gastrectomy patients: emphasis on technique , 1999, American Journal of Gastroenterology.

[28]  J. Tijssen,et al.  Randomised trial of endoscopic balloon dilation versus endoscopic sphincterotomy for removal of bileduct stones , 1997, The Lancet.

[29]  S. Myung,et al.  Endoscopic Retrograde Cholangiopancreatography and Needle-Knife Sphincterotomy in Patients with Billroth II Gastrectomy: A Comparative Study of the Forward-viewing Endoscope and the Side-viewing Duodenoscope , 1997, Endoscopy.

[30]  C Liguory,et al.  Endoscopic sphincterotomy complications and their management: an attempt at consensus. , 1991, Gastrointestinal endoscopy.