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CC BY-NC-ND 4.0 · Endosc Int Open 2022; 10(06): E905-E909
DOI: 10.1055/a-1789-0238
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Use of modified therapeutic upper endoscope for ERCP in patients post pancreaticoduodenectomy

Nicholas M. McDonald
1   University of Minnesota Medical Center, Division of Gastroenterology, Hepatology, and Nutrition, Minneapolis, Minnesota, United States
,
Mohamed Abdallah
1   University of Minnesota Medical Center, Division of Gastroenterology, Hepatology, and Nutrition, Minneapolis, Minnesota, United States
,
Dharma Sunjaya
1   University of Minnesota Medical Center, Division of Gastroenterology, Hepatology, and Nutrition, Minneapolis, Minnesota, United States
2   Minneapolis VA Health Care System, Division of Gastroenterology and Hepatology, Minneapolis, Minnesota, United States
,
Mohammad Bilal
1   University of Minnesota Medical Center, Division of Gastroenterology, Hepatology, and Nutrition, Minneapolis, Minnesota, United States
2   Minneapolis VA Health Care System, Division of Gastroenterology and Hepatology, Minneapolis, Minnesota, United States
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Introduction

Since the invention of endoscopic retrograde cholangioscopy (ERCP) in 1968, the procedure has continued to evolve and has become integral to modern management of pancreaticobiliary disease [1]. While ERCP is commonly performed, in patients with gastric or small bowel surgically altered anatomy (SAA), the procedure may pose substantial technical challenges, resulting in failure [2] [3] [4] [5] [6]. Common types of SAA posing unique challenges to ERCP include Billroth I gastrectomy, Billroth II gastrectomy, Roux-en-Y gastric bypass, and pancreaticoduodenectomy, also known as a Whipple procedure [2] [3] [4] [5] [6]. Anatomical challenges in ERCP for SAA are often associated with difficulties in intubation of the anastomosis, length of the biliopancreatic (afferent) limb, inability to cannulate the biliary tree through the anastomosis, lack of an elevator mechanism, or endoscope incompatibility with the required endoscopic accessories [2].

In cases of ERCP in patients with pancreaticoduodenectomy anatomy, multiple types of endoscopes have been used, with a traditional side-viewing duodenoscope being the most common [7]. Chahal et al have previously evaluated outcomes of ERCP in patients with pancreaticoduodenectomy. In their series of 88 patients with pancreaticoduodenectomy who underwent ERCP, they found a 51 % technical success rate and low rates of adverse events (AEs) [7]. In this series, a conventional side-viewing duodenoscope was used in all the cases; in the 14.8 % of cases in which the conventional duodenoscope failed in successful completion for ERCP, an adult or pediatric colonoscope was utilized.

Conventional ERCP with a side-viewing duodenoscope allows for therapeutic interventions including sphincteroplasty, stone extraction, tissue sampling, stent placement, and more [2]. Adult or pediatric colonoscopes offer the advantage of being forward-viewing, and the longer length makes it possible to reach the biliary limb. Other options include using balloon enteroscopy-assisted ERCP [8] [9]. When a conventional duodenoscope cannot be used, each approach (adult and pediatric colonoscope, and balloon enteroscopy-assisted ERCP) has its advantages and potential limitations. Here we present our preliminary experience utilizing the newer modified therapeutic upper endoscope (1T; GIF-1TH190 Olympus, Center Valley, Pennsylvania, United States) for ERCP in patients with pancreaticoduodenectomy after a failed attempt with a conventional duodenoscope.



Publikationsverlauf

Eingereicht: 08. Oktober 2021

Angenommen nach Revision: 03. März 2022

Accepted Manuscript online:
04. März 2022

Artikel online veröffentlicht:
10. Juni 2022

© 2022. The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/)

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  • References

  • 1 Kozarek RA. The past, present, and future of endoscopic retrograde cholangiopancreatography. Gastroenterol Hepatol 2017; 13: 620-622
    PubMedGoogle Scholar
  • 2 Moreels TG. ERCP in the patient with surgically altered anatomy. Curr Gastroenterol Rep 2013; 15: 343
    CrossrefPubMedGoogle Scholar
  • 3 Krutsri C, Kida M, Yamauchi H. et al. Current status of endoscopic retrograde cholangiopancreatography in patients with surgically altered anatomy. World J Gastroenterol 2019; 25: 3313-3333
    CrossrefPubMedGoogle Scholar
  • 4 Osnes M, Rosseland AR, Aabakken L. Endoscopic retrograde cholangiography and endoscopic papillotomy in patients with a previous Billroth-II resection. Gut 1986; 27: 1193-1198
    CrossrefPubMedGoogle Scholar
  • 5 Park ET. Endoscopic retrograde cholangiopancreatography in bilioenteric anastomosis. Clin Endosc 2016; 49: 510-514
    CrossrefPubMedGoogle Scholar
  • 6 Lichtenstein DR. Post-surgical Anatomy and ERCP. Tech Gastrointest Endosc 2007; 9: 114-124
    CrossrefPubMedGoogle Scholar
  • 7 Chahal P, Baron TH, Topazian MD. et al. Endoscopic retrograde cholangiopancreatography in post-Whipple patients. Endosc 2006; 38: 1241-1245
    Artikel in Thieme ConnectPubMedGoogle Scholar
  • 8 Inamdar S, Slattery E, Sejpal D v. et al. Systematic review and meta-analysis of single-balloon enteroscopy-assisted ERCP in patients with surgically altered GI anatomy. Gastrointest Endosc 2015; 82: 9-19
    CrossrefPubMedGoogle Scholar
  • 9 Trindade AJ, Mella JM, Slattery E. et al. Use of a cap in single-balloon enteroscopy-assisted endoscopic retrograde cholangiography. Endoscopy 2015; 47: 453-456
    PubMedGoogle Scholar
  • 10 Kodali VP, Petersen BT, Miller CA. et al. A new jumbo-channel therapeutic gastroscope for acute upper gastrointestinal bleeding. Gastrointestinal endoscopy 1997; 45: 409-411
    CrossrefPubMedGoogle Scholar
  • 11 Enestvedt BK, Kothari S, Pannala R. et al. Devices and techniques for ERCP in the surgically altered GI tract. Gastrointest Endosc 2016; 83: 1061-1075
    CrossrefPubMedGoogle Scholar