Success of ERCP with single-balloon enteroscope in patients with post-surgical modified anatomy

Aims To analyze ERCP procedures performed with a single-balloon enteroscope in a tertiary care center between 2015 and August 2024. All procedures were conducted with a 200 cm enteroscope with a 2.8 mm working channel.

Methods Retrospective study with statistical analysis using Chi-square in SPSS

Results A total of 57 patients (mean age: 69.5 years) were included, with a total of 69 procedures (some cases required a repeat enteroscopy due to technical failure or new indication). Forty-seven percent of patients (27) had a hepaticojejunostomy (11 Roux-en-Y for Whipple, 16 Roux-en-Y biliary surgeries), with the remaining patients having a native papilla (12 partial gastrectomy in Roux-en-Y, 8 total gastrectomy in Roux-en-Y, 10 gastric bypass). The primary indication was choledocholithiasis (67%), followed by benign biliary stricture (20%) and bile leak (6%).Enteroscopic success was defined as reaching the papilla or bilioenteric anastomosis (71%), achieving cannulation in 42 cases. In both cases, success was higher in Roux-en-Y biliary surgery (35% and 40%, respectively). The cannulation rate in hepaticojejunostomy was higher than in native papilla (92% vs 80%). Therapeutic success, defined as resolution of the indication, was achieved in 34 patients. Regarding failures, most were due to failure to reach the papilla (53%), followed by papilla not visualized (29%). In cases of therapeutic failure, a new enteroscopy was attempted in 26% of cases, followed by Rendez-vous with percutaneous access.

Conclusions The literature suggests a lower success rate of enteroscopy in patients with Roux-en-Y gastric bypass, likely due to the increased distance to the anastomosis. In our series, the success rate was 50% in patients with gastric bypass and 75.4% in the rest, without reaching statistical significance (p=0.078). Although some studies suggest greater success in cannulating patients with hepaticojejunostomy, our sample did not show significant differences between the two groups (p=0.243).

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Artikel online veröffentlicht:
27. März 2025