AIM To examine the utility of endoscopic retrograde cholangiopancreatography(ERCP) on biliopancreatic diseases in the patients with Billroth II-reconstructed stomach.METHODS For 26 cases of biliopancreatic diseases in...AIM To examine the utility of endoscopic retrograde cholangiopancreatography(ERCP) on biliopancreatic diseases in the patients with Billroth II-reconstructed stomach.METHODS For 26 cases of biliopancreatic diseases in patients with Billroth Ⅱ-reconstructed stomach,ERCP was conducted using a straight-view scope or a retrograde obliqueviewing endoscope.All the cases were patients aiming at selective insertion into the bile duct.One patient aimed at diagnosis,and 25 patients aimed at treatment.The cases in which the endoscope reached the duodenal papilla and anastomosis,and insertion into the bile duct became possible,were considered successful.RESULTS The rate of reaching the duodenal papilla and anastomosis was 84.7%(22/26 patients).Among the cases without reaching the duodenal papilla and anastomosis,there were 2 in which the endoscope did not pass due to tumor-induced duodenal infiltration.In 1 case,the fiber did not reach the duodenal papilla due to long afferent loop.The success rate of insertion into the bile duct in patients in which the endoscope reached the duodenal papilla and anastomosis was 90.9%(20/22 patients),and the success rate of procedures including treatment was 86.3%(19/22 patients).After treatment,mild cholangitis was observed in 1 patient(4.5%,1/22 patients) but relieved conservatively.No other accidental symptom was observed.CONCLUSION It was considered that the ERCP for biliopancreatic diseases in patients with Billroth II-reconstructed stomach will become a less invasive,safe and useful examination and treatment approach.展开更多
BACKGROUND Endoscopic retrograde cholangiopancreatography(ERCP)in patients with Billroth Ⅱ gastrectomy has been considered a challenging procedure due to the surgically altered gastrointestinal anatomy.However,there ...BACKGROUND Endoscopic retrograde cholangiopancreatography(ERCP)in patients with Billroth Ⅱ gastrectomy has been considered a challenging procedure due to the surgically altered gastrointestinal anatomy.However,there has been a paucity of comparative studies regarding ERCP in Billroth Ⅱ gastrectomy cases because of procedure-related morbidity and mortality and practical and ethical limitations.This systematic and comprehensive review was performed to obtain a recent perspective on ERCP in Billroth Ⅱ gastrectomy patients.AIM To systematically review the literature regarding ERCP in Billroth Ⅱ gastrectomy patients.METHODS A systematic review was performed on the literature published between May 1975 and January 2019.The following electronic databases were searched:PubMed,EMBASE,and Cochrane Library.The outcomes of successful afferent loop intubation and successful selective cannulation and occurrence of adverse events were assessed.RESULTS A total of 43 studies involving 2669 patients were included.The study designs were 36(83.7%)retrospective cohort studies,4(9.3%)retrospective comparative studies,2(4.7%)prospective comparative studies,and 1(2.3%)prospective cohort study.Of a total of 2669 patients,there were 1432 cases(55.6%)of sideviewing endoscopy,664(25.8%)cases of forward-viewing endoscopy,171(6.6%)cases of balloon-assisted enteroscopy,169(6.6%)cases of anterior obliqueviewing endoscopy,64(2.5%)cases of dual-lumen endoscopy,31(1.2%)cases of colonoscopy,and 14(0.5%)cases of multiple bending endoscopy.The overall success rate of afferent loop intubation was 91.3%(2437/2669),and the overall success rate of selective cannulation was 87.9%(2346/2437).A total of 195 cases(7.3%)of adverse events occurred.The success rates of afferent loop intubation and the selective cannulation rate for each type of endoscopy were as follows:side-viewing endoscopy 98.2%and 95.3%;forward-viewing endoscopy 97.4%and 95.2%;balloon-assisted enteroscopy 95.4%and 97.5%;oblique-viewing endoscopy 94.1%and 97.5%;and dual-lumen endoscopy 82.8%and 100%,respectively.The rate of bowel perforation was slightly higher in side-viewing endoscopy(3.6%)and balloon-assisted enteroscopy(4.1%)compared with forward-viewing endoscopy(1.7%)and anterior oblique-viewing endoscopy(1.2%).Mortality only occurred in side-viewing endoscopy(n=9,0.6%).CONCLUSION The performance of ERCP in the Billroth Ⅱ gastrectomy population has been improving with choice of various type of endoscope and sphincter management.More comparative studies are needed to determine the optimal strategy to perform safe and effective ERCP in Billroth Ⅱ gastrectomy patients.展开更多
BACKGROUND Endoscopic retrograde cholangiopancreatography(ERCP) in patients with surgically altered anatomy has been a major challenge to gastrointestinal endoscopists with low success rates for reaching the target si...BACKGROUND Endoscopic retrograde cholangiopancreatography(ERCP) in patients with surgically altered anatomy has been a major challenge to gastrointestinal endoscopists with low success rates for reaching the target site as well as high complication rates. The knowledge of ERCP-related risk factors is important for reducing unexpected complications.AIM To identify ERCP-related risk factors for perforation in patients with surgically altered anatomy.METHODS The medical records of 187 patients with surgically altered anatomy who underwent ERCP at our institution between April 2009 and December 2017 were retrospectively reviewed. An analysis of patient data, including age, sex, type of reconstruction, cause of surgery, aim of ERCP, success rate of reaching target site,success rate of procedure, adverse events, type of scope, time to reach the target site, and duration of procedure, was performed. In patients with Billroth-Ⅱ reconstruction, additional potential risk factors were the shape of the inserted scope and whether the anastomosis was antecolic or retrocolic.RESULTS All patients(n = 187) had surgical anatomy, such as Billroth-Ⅰ(n = 22), Billroth-Ⅱ(n = 33), Roux-en-Y(n = 54), Child, or Whipple reconstruction(n = 75). ERCP was performed for biliary drainage in 43 cases(23%), stone removal in 29 cases(16%),and stricture dilation of anastomosis in 59 cases(32%). The scope was unable to reach the target site in 17 cases(9%), and an aimed procedure could not be accomplished in 54 cases(29%). Adverse events were pancreatitis(3%),hyperamylasemia(10%), cholangitis(6%), cholestasis(4%), excessive sedation(1%), perforation(2%), and others(3%). Perforation occurred in three cases, all of which were in patients with Billroth-Ⅱ reconstruction; in these patients, further analysis revealed loop-shaped insertion of the scope to be a significant risk for perforation(P = 0.01).CONCLUSION Risk factors for perforation during ERCP in patients with surgically altered anatomy were Billroth-Ⅱ reconstruction and looping of the scope during BillrothⅡ procedure.展开更多
AIM:To evaluate the effect of double balloon endoscope(DBE)on the endoscopic retrograde cholangio-pancreatography(ERCP)success rate in patients with a history of BillrothⅡ(BⅡ)gastrectomy.METHODS:From April 2006 to M...AIM:To evaluate the effect of double balloon endoscope(DBE)on the endoscopic retrograde cholangio-pancreatography(ERCP)success rate in patients with a history of BillrothⅡ(BⅡ)gastrectomy.METHODS:From April 2006 to March 2007,32 patients with a BⅡgastrectomy underwent 34 ERCP attempts.In all cases,the ERCP procedures were started using a duodenoscope.If intubation of the afferent loop or reaching the papilla failed,we changed to DBE for the ERCP procedure(DBE-ERCP).We assessed the success rate of afferent loop intubation,reaching the major papilla,selective cannulation,possibility of therapeutic approaches,procedure-related complications,and the overall success rate.RESULTS:Among the 32 patients with a history of BⅡgastrectomy,the duodenoscope was successfully passed up to the papilla in 22 patients(69%),and cannulation was successfully performed in 20 patients(63%).Six patients(2 with failure in afferent loop intubation and 4 with failure in reaching the papilla)underwent DBE-ERCP.The DBE reached the papilla in all the 6 patients(100%)and selective cannulation was successful in 5 patients(83%).Four patients(67%)who had common bile duct stones were successfully treated.One patient underwent diagnostic ERCP only and the other one,in whom selective cannulation failed,was diagnosed with papilla cancer proven by biopsy.There were no complications related to the DBE.The overall ERCP success rate increased to 88%(28/32).CONCLUSION:The overall ERCP success rate increases with DBE in patients with a previous BⅡgastrectomy.展开更多
Endoscopic retrograde cholangiopancreatography(ERCP)is efficacious in patients who have undergone Billroth Ⅱ gastroenterostomies,but the success rate decreases in patients who also have experienced Braun anastomoses....Endoscopic retrograde cholangiopancreatography(ERCP)is efficacious in patients who have undergone Billroth Ⅱ gastroenterostomies,but the success rate decreases in patients who also have experienced Braun anastomoses.There are currently no reports describing the preferred enterography route for cannulation in these patients.We first review the patient’s previous surgery records,which most often indicate that the efferent loop is at the greater curvature of the stomach.We recommend extending the duodenoscope along the greater curvature of the stomach and then advancing it through the"lower entrance"at the site of the gastrojejunal anastomosis,along the efferent loop,and through the"middle entrance"at the site of the Braun anastomosis to reach the papilla of Vater.Ten patients who had each undergone BillrothⅡgastroenterostomy and Braun anastomosis between January 2009 and December 2011 were included in our study.The overall success rate of enterography was 90% for the patients who had undergone BillrothⅡgastroenterostomy and Braun anastomosis,and the therapeutic success rate was 80%.We believe that this enterography route for ERCP is optimal for a patient who has had BillrothⅡgastroenterostomy and Braun anastomosis and helps to increase the success rate of the procedure.展开更多
AIM: To describe an optimal route to the Braun anastomosis including the use of retrieval-balloon-assisted enterography.METHODS: Patients who received a Billroth Ⅱ gastroenterostomy(n = 109) and a Billroth Ⅱ gastroe...AIM: To describe an optimal route to the Braun anastomosis including the use of retrieval-balloon-assisted enterography.METHODS: Patients who received a Billroth Ⅱ gastroenterostomy(n = 109) and a Billroth Ⅱ gastroenterostomy with Braun anastomosis(n = 20) between January 2009 and May 2013 were analyzed in this study. Endoscopic ret-rograde cholangiopancreatography(ERCP) was performed under fluoroscopic control using a total length of 120 cm oblique-viewing duodenoscope with a 3.7-mm diameter working channel. For this procedure, we used a triplelumen retrieval balloon catheter in which a 0.035-inch guidewire could be inserted into the "open-channel" guidewire lumen while the balloon could be simultaneously injected and inflated through the other 2 lumens.RESULTS: For the patients with Billroth Ⅱ gastroenterostomy and Braun anastomosis, successful access to the papilla was gained in 17 patients(85%) and there was therapeutic success in 16 patients(80%). One patient had afferent loop perforation, but postoperative bleeding did not occur. For Billroth Ⅱ gastroenterostomy, there was failure in accessing the papilla in 15 patients(13.8%). ERCP was unsuccessful because of tumor infiltration(6 patients), a long afferent loop(9 patients), and cannulation failure(4 patients). The papilla was successfully accessed in 94 patients(86.2%), and there was therapeutic success in 90 patients(82.6%). Afferent loop perforation did not occur in any of these patients. One patient had hemorrhage 2 h after ERCP, which was successfully managed with conservative treatment.CONCLUSION: Retrieval-balloon-assisted enterography along an optimal route may improve the ERCP success rate after Billroth Ⅱ gastroenterostomy and Braun anastomosis.展开更多
文摘AIM To examine the utility of endoscopic retrograde cholangiopancreatography(ERCP) on biliopancreatic diseases in the patients with Billroth II-reconstructed stomach.METHODS For 26 cases of biliopancreatic diseases in patients with Billroth Ⅱ-reconstructed stomach,ERCP was conducted using a straight-view scope or a retrograde obliqueviewing endoscope.All the cases were patients aiming at selective insertion into the bile duct.One patient aimed at diagnosis,and 25 patients aimed at treatment.The cases in which the endoscope reached the duodenal papilla and anastomosis,and insertion into the bile duct became possible,were considered successful.RESULTS The rate of reaching the duodenal papilla and anastomosis was 84.7%(22/26 patients).Among the cases without reaching the duodenal papilla and anastomosis,there were 2 in which the endoscope did not pass due to tumor-induced duodenal infiltration.In 1 case,the fiber did not reach the duodenal papilla due to long afferent loop.The success rate of insertion into the bile duct in patients in which the endoscope reached the duodenal papilla and anastomosis was 90.9%(20/22 patients),and the success rate of procedures including treatment was 86.3%(19/22 patients).After treatment,mild cholangitis was observed in 1 patient(4.5%,1/22 patients) but relieved conservatively.No other accidental symptom was observed.CONCLUSION It was considered that the ERCP for biliopancreatic diseases in patients with Billroth II-reconstructed stomach will become a less invasive,safe and useful examination and treatment approach.
文摘BACKGROUND Endoscopic retrograde cholangiopancreatography(ERCP)in patients with Billroth Ⅱ gastrectomy has been considered a challenging procedure due to the surgically altered gastrointestinal anatomy.However,there has been a paucity of comparative studies regarding ERCP in Billroth Ⅱ gastrectomy cases because of procedure-related morbidity and mortality and practical and ethical limitations.This systematic and comprehensive review was performed to obtain a recent perspective on ERCP in Billroth Ⅱ gastrectomy patients.AIM To systematically review the literature regarding ERCP in Billroth Ⅱ gastrectomy patients.METHODS A systematic review was performed on the literature published between May 1975 and January 2019.The following electronic databases were searched:PubMed,EMBASE,and Cochrane Library.The outcomes of successful afferent loop intubation and successful selective cannulation and occurrence of adverse events were assessed.RESULTS A total of 43 studies involving 2669 patients were included.The study designs were 36(83.7%)retrospective cohort studies,4(9.3%)retrospective comparative studies,2(4.7%)prospective comparative studies,and 1(2.3%)prospective cohort study.Of a total of 2669 patients,there were 1432 cases(55.6%)of sideviewing endoscopy,664(25.8%)cases of forward-viewing endoscopy,171(6.6%)cases of balloon-assisted enteroscopy,169(6.6%)cases of anterior obliqueviewing endoscopy,64(2.5%)cases of dual-lumen endoscopy,31(1.2%)cases of colonoscopy,and 14(0.5%)cases of multiple bending endoscopy.The overall success rate of afferent loop intubation was 91.3%(2437/2669),and the overall success rate of selective cannulation was 87.9%(2346/2437).A total of 195 cases(7.3%)of adverse events occurred.The success rates of afferent loop intubation and the selective cannulation rate for each type of endoscopy were as follows:side-viewing endoscopy 98.2%and 95.3%;forward-viewing endoscopy 97.4%and 95.2%;balloon-assisted enteroscopy 95.4%and 97.5%;oblique-viewing endoscopy 94.1%and 97.5%;and dual-lumen endoscopy 82.8%and 100%,respectively.The rate of bowel perforation was slightly higher in side-viewing endoscopy(3.6%)and balloon-assisted enteroscopy(4.1%)compared with forward-viewing endoscopy(1.7%)and anterior oblique-viewing endoscopy(1.2%).Mortality only occurred in side-viewing endoscopy(n=9,0.6%).CONCLUSION The performance of ERCP in the Billroth Ⅱ gastrectomy population has been improving with choice of various type of endoscope and sphincter management.More comparative studies are needed to determine the optimal strategy to perform safe and effective ERCP in Billroth Ⅱ gastrectomy patients.
文摘BACKGROUND Endoscopic retrograde cholangiopancreatography(ERCP) in patients with surgically altered anatomy has been a major challenge to gastrointestinal endoscopists with low success rates for reaching the target site as well as high complication rates. The knowledge of ERCP-related risk factors is important for reducing unexpected complications.AIM To identify ERCP-related risk factors for perforation in patients with surgically altered anatomy.METHODS The medical records of 187 patients with surgically altered anatomy who underwent ERCP at our institution between April 2009 and December 2017 were retrospectively reviewed. An analysis of patient data, including age, sex, type of reconstruction, cause of surgery, aim of ERCP, success rate of reaching target site,success rate of procedure, adverse events, type of scope, time to reach the target site, and duration of procedure, was performed. In patients with Billroth-Ⅱ reconstruction, additional potential risk factors were the shape of the inserted scope and whether the anastomosis was antecolic or retrocolic.RESULTS All patients(n = 187) had surgical anatomy, such as Billroth-Ⅰ(n = 22), Billroth-Ⅱ(n = 33), Roux-en-Y(n = 54), Child, or Whipple reconstruction(n = 75). ERCP was performed for biliary drainage in 43 cases(23%), stone removal in 29 cases(16%),and stricture dilation of anastomosis in 59 cases(32%). The scope was unable to reach the target site in 17 cases(9%), and an aimed procedure could not be accomplished in 54 cases(29%). Adverse events were pancreatitis(3%),hyperamylasemia(10%), cholangitis(6%), cholestasis(4%), excessive sedation(1%), perforation(2%), and others(3%). Perforation occurred in three cases, all of which were in patients with Billroth-Ⅱ reconstruction; in these patients, further analysis revealed loop-shaped insertion of the scope to be a significant risk for perforation(P = 0.01).CONCLUSION Risk factors for perforation during ERCP in patients with surgically altered anatomy were Billroth-Ⅱ reconstruction and looping of the scope during BillrothⅡ procedure.
文摘AIM:To evaluate the effect of double balloon endoscope(DBE)on the endoscopic retrograde cholangio-pancreatography(ERCP)success rate in patients with a history of BillrothⅡ(BⅡ)gastrectomy.METHODS:From April 2006 to March 2007,32 patients with a BⅡgastrectomy underwent 34 ERCP attempts.In all cases,the ERCP procedures were started using a duodenoscope.If intubation of the afferent loop or reaching the papilla failed,we changed to DBE for the ERCP procedure(DBE-ERCP).We assessed the success rate of afferent loop intubation,reaching the major papilla,selective cannulation,possibility of therapeutic approaches,procedure-related complications,and the overall success rate.RESULTS:Among the 32 patients with a history of BⅡgastrectomy,the duodenoscope was successfully passed up to the papilla in 22 patients(69%),and cannulation was successfully performed in 20 patients(63%).Six patients(2 with failure in afferent loop intubation and 4 with failure in reaching the papilla)underwent DBE-ERCP.The DBE reached the papilla in all the 6 patients(100%)and selective cannulation was successful in 5 patients(83%).Four patients(67%)who had common bile duct stones were successfully treated.One patient underwent diagnostic ERCP only and the other one,in whom selective cannulation failed,was diagnosed with papilla cancer proven by biopsy.There were no complications related to the DBE.The overall ERCP success rate increased to 88%(28/32).CONCLUSION:The overall ERCP success rate increases with DBE in patients with a previous BⅡgastrectomy.
基金Supported by Shanghai Education Commission Scientific Research and Innovation ProjectNo.11YZ55
文摘Endoscopic retrograde cholangiopancreatography(ERCP)is efficacious in patients who have undergone Billroth Ⅱ gastroenterostomies,but the success rate decreases in patients who also have experienced Braun anastomoses.There are currently no reports describing the preferred enterography route for cannulation in these patients.We first review the patient’s previous surgery records,which most often indicate that the efferent loop is at the greater curvature of the stomach.We recommend extending the duodenoscope along the greater curvature of the stomach and then advancing it through the"lower entrance"at the site of the gastrojejunal anastomosis,along the efferent loop,and through the"middle entrance"at the site of the Braun anastomosis to reach the papilla of Vater.Ten patients who had each undergone BillrothⅡgastroenterostomy and Braun anastomosis between January 2009 and December 2011 were included in our study.The overall success rate of enterography was 90% for the patients who had undergone BillrothⅡgastroenterostomy and Braun anastomosis,and the therapeutic success rate was 80%.We believe that this enterography route for ERCP is optimal for a patient who has had BillrothⅡgastroenterostomy and Braun anastomosis and helps to increase the success rate of the procedure.
基金Supported by Leading Talent program of Shanghai,Sailing program of Shanghai science and technology commission NO.14YF1403000
文摘AIM: To describe an optimal route to the Braun anastomosis including the use of retrieval-balloon-assisted enterography.METHODS: Patients who received a Billroth Ⅱ gastroenterostomy(n = 109) and a Billroth Ⅱ gastroenterostomy with Braun anastomosis(n = 20) between January 2009 and May 2013 were analyzed in this study. Endoscopic ret-rograde cholangiopancreatography(ERCP) was performed under fluoroscopic control using a total length of 120 cm oblique-viewing duodenoscope with a 3.7-mm diameter working channel. For this procedure, we used a triplelumen retrieval balloon catheter in which a 0.035-inch guidewire could be inserted into the "open-channel" guidewire lumen while the balloon could be simultaneously injected and inflated through the other 2 lumens.RESULTS: For the patients with Billroth Ⅱ gastroenterostomy and Braun anastomosis, successful access to the papilla was gained in 17 patients(85%) and there was therapeutic success in 16 patients(80%). One patient had afferent loop perforation, but postoperative bleeding did not occur. For Billroth Ⅱ gastroenterostomy, there was failure in accessing the papilla in 15 patients(13.8%). ERCP was unsuccessful because of tumor infiltration(6 patients), a long afferent loop(9 patients), and cannulation failure(4 patients). The papilla was successfully accessed in 94 patients(86.2%), and there was therapeutic success in 90 patients(82.6%). Afferent loop perforation did not occur in any of these patients. One patient had hemorrhage 2 h after ERCP, which was successfully managed with conservative treatment.CONCLUSION: Retrieval-balloon-assisted enterography along an optimal route may improve the ERCP success rate after Billroth Ⅱ gastroenterostomy and Braun anastomosis.