NEW METHOD TO INSERT LARGE CALIBER PLASTIC AND SELF-EXPANDING METAL STENTS (SEMS) DURING BALLOON OVERTUBE ENTEROSCOPY (BAE) ASSISTED ERCP

Aims:

To demonstrate a new method to deliver self-expanding metal and large diameter plastic stents during DBE-ERCP in patients with surgically altered upper GI tract anatomy.

Methods:

Retrospective, observational, cohort study at a single tertiary, academic institution during a 3-year period evaluating patients with complex post-surgical anatomy and undergoing BAE-ERCP. We focused on a new technique of BAE ERCP, which allowed for the insertion of large bore plastic stents and SEMS, which is impossible when using the standard enteroscope, as its working channel is only 2,8 to 3,2 mm in diameter. SEMS and 10 Fr plastic stents require working channels larger than 3,2 mm.

Results:

We performed a total of 105 BAE-ERCPs in 90 patients. The BAE-ERCP rendezvous and overtube-in-situ technique was utilized 10 times in 8 patients (8,8%, female n = 4, male n = 4, mean age 54.4, range 22 – 82). Indications were cholangitis n = 4, choledocolithaisis n = 6, cancer obstructing the hepaticojejunostomy (HJ) n = 2. The post-surgical anatomy was Roux-en-Y HJ n = 5, RY gastric bypass n = 1, Billroth II n = 1. Four patients had undergone a liver transplant, three patients had undergone Whipple's operation for pancreatic cancer, one patient had undergone RY hepaticojejunostomy for a choledocal cyst during childhood. The technique was successful in all patients. In 50% patients other interventions such direct cholangioscopy, dilation and EHL could be performed using this new technique. The mean duration of the procedure was 65 minutes, range 45 to 125 min. There were no major adverse events.

Conclusions:

The insertion of metal stents using this modified BAE-ERCP technique was feasible and successful, thus increasing our therapeutic capabilities in patients with complex post-surgical upper GI anatomy and biliary problems.