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Predictors of success for double balloon‐assisted endoscopic retrograde cholangiopancreatography in patients with Roux‐en‐Y anastomosis
Author(s) -
Liu Ken,
Joshi Vikram,
Saxena Payal,
Kaffes Arthur J.
Publication year - 2017
Publication title -
digestive endoscopy
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.5
H-Index - 56
eISSN - 1443-1661
pISSN - 0915-5635
DOI - 10.1111/den.12739
Subject(s) - medicine , endoscopic retrograde cholangiopancreatography , biliary atresia , anastomosis , roux en y anastomosis , bile duct , surgery , biliary tract , liver transplantation , transplantation , gastric bypass , pancreatitis , weight loss , obesity
Background and Aim Endoscopic retrograde cholangiopancreatography ( ERCP ) in patients with roux‐en‐Y anastomosis ( REYA ) is challenging. Use of double balloon enteroscope‐assisted ERCP ( DBE ‐ ERCP ) has been successful. We aim to determine predictors of successful biliary cannulation with DBE ‐ ERCP in patients with REYA . Methods We retrospectively studied patients with REYA who had DBE ‐ ERCP between 2009 and 2015. Results 86 DBE ‐ ERCP were done on 52 patients. Patients had REYA for liver transplant ( n = 26), gastrojejunostomy ( n = 9), previous bile duct injury ( n = 9), biliary atresia ( n = 2) and other ( n = 6). The biliary‐enteric anastomosis was reached in 76% and cholangiogram was successful in 70%. Highest success rates were in patients with previous bile duct injury (94%) or gastrojejunostomy (89%). Post‐transplant patients had intermediate success (64%). Patients with redo surgery (46%) and childhood surgery (38%), especially Kasai procedure (20%), had low success. Patients with previous bile duct injury were more likely to succeed (94% vs 63%, P = 0.010). Those more likely to fail were patients with childhood surgery (38% vs 73%, P = 0.037), biliary atresia (20% vs 73%, P = 0.013) and second operation post‐transplant (25% vs 70%, P = 0.046). Conclusion Indication for REYA impacts on successful biliary cannulation in patients undergoing DBE ‐ ERCP . The procedure is most successful in non‐liver transplant adult surgery and post‐transplant patients without a second operation. It is least successful in patients with surgically corrected biliary atresia and post‐transplant patients with second operation. Alternative methods of biliary access should be considered in these patients.