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Analysis of the factors involved in procedural failure: Endoscopic retrograde cholangiopancreatography using a short‐type single‐balloon enteroscope for patients with surgically altered gastrointestinal anatomy
Author(s) -
Tanisaka Yuki,
Ryozawa Shomei,
Mizuide Masafumi,
Harada Maiko,
Fujita Akashi,
Ogawa Tomoya,
aka Kouichi,
Tashima Tomoaki,
Araki Ryuichiro
Publication year - 2019
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.13414
Subject(s) - medicine , endoscopic retrograde cholangiopancreatography , fluoroscopy , major duodenal papilla , balloon , surgery , radiology , odds ratio , percutaneous , balloon dilation , pancreatitis
Aim To analyze factors involved in procedural failure and to discuss responses to procedural failure by using the outcomes of endoscopic retrograde cholangiopancreatography ( ERCP ) carried out using a short‐type single‐balloon enteroscope (short SBE ) in patients with surgically altered gastrointestinal anatomy. Methods The study sample included patients who underwent ERCP ‐related procedures using a short SBE between September 2011 and September 2018 at our hospital. Outcomes, including procedural success rate, were studied retrospectively to analyze the factors involved in procedural failure. Results Analysis included 191 procedures carried out in 121 patients. Procedural success rate was 85.9% with an adverse event rate of 8.4%. Causes of procedural failure included malignant biliary obstruction (odds ratio [ OR ] 2.89, 95% confidence interval [ CI ] 1.19–7.25, P = 0.02), first ERCP attempt (OR: 5.32, 95% CI: 1.30–36.30, P = 0.02), and Roux‐en‐Y reconstruction (OR: 0.08, 95% CI: 0.004–0.39, P < 0.001). With regard to the response to failure, in cases of malignant biliary obstruction, reattempted short SBE ‐assisted ERCP was difficult because of invasion of the small intestine or papilla. A large number of these cases required alternative treatment (10 of 15 cases, 66.7%) using percutaneous transhepatic biliary drainage ( PTBD ) or endoscopic ultrasound‐guided biliary drainage ( EUS ‐ BD ). Conclusion Endoscopic retrograde cholangiopancreatography using a short SBE is safe and effective, with malignant biliary obstruction being a specific cause of failure. Technical proficiency with different modalities, such as PTBD and EUS ‐ BD , is necessary to respond to failure in these cases.