Motorized Spiral Enteroscopy-Assisted ERCP in Altered Gastrointestinal Anatomy: First Clinical Series

Aims Recently novel motorized spiral enteroscopy (MSE) has been introduced into clinical practice and has been shown to be safe and effective for deep enteroscopy in patients without previous abdominal surgery. MSE has not yet been studied in patients with surgically altered anatomy of the upper gastrointestinal tract. ERCP in this group of patients often needs device assisted enteroscopy, in particular after Roux-en-Y reconstructive surgery. In this first series we evaluate feasibility and safety of MSE-assisted ERCP.

Methods All patients undergoing MSE-assisted ERCP after Roux-en-Y reconstructive surgery were retrospectively analyzed at a tertiary reference center since 2016.

Results Overall, 21 patients (10 female, 11 male) with a median age of 67 years (range 46-87) could be identified. All patients had co-morbidities (ASA II 19 %, ASA III 81 %). Indications for ERCP included biliary strictures (n = 12), biliary stones (n = 6) and others (n = 3). All patients had a Roux-en-Y-anatomy. Technical success rate of MSE (reaching the papilla or bilio-enteric anastomosis) was 85,7 % (18/21). Overall success rate of ERCP (successful cholangiogram) was 83.3 % (15/18). After biliary cannulation, therapeutic interventions were successfully performed in all patients including balloon-dilation (n = 11), stenting (n = 8) including two implantations of a self-expandable metal stents, stone extraction (n = 4), stent extraction (n = 4), tissue acquisition from stricture (n = 2) and needle-knife precut-sphincterotomy (n = 1). Median total procedure time was 72 minutes (range 42-165). Adverse event rate was 4,8 % (self-limiting prolonged bleeding after balloon dilatation of the bilio-enteric anastomosis in one patient). No serious adverse events were registered.

Conclusions The current series showed for the first time the feasibility of MSE for ERCP in patients with surgically altered upper gastrointestinal anatomy. The results indicate that biliary access and therapeutic interventions can be achieved in most of the cases with a low rate of adverse events. These data justify further evaluation of this new technique preferably in a prospective multicenter trial.

Publication History

Article published online:
19 March 2021