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Copyright ©The Author(s) 2015. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastroenterol. Jun 7, 2015; 21(21): 6460-6469
Published online Jun 7, 2015. doi: 10.3748/wjg.v21.i21.6460
Innovations and techniques for balloon-enteroscope-assisted endoscopic retrograde cholangiopancreatography in patients with altered gastrointestinal anatomy
Hiroshi Yamauchi, Mitsuhiro Kida, Hiroshi Imaizumi, Kosuke Okuwaki, Shiro Miyazawa, Tomohisa Iwai, Wasaburo Koizumi
Hiroshi Yamauchi, Mitsuhiro Kida, Hiroshi Imaizumi, Kosuke Okuwaki, Shiro Miyazawa, Tomohisa Iwai, Wasaburo Koizumi, Department of Gastroenterology, Kitasato University Hospital, Sagamihara, Kanagawa 252-0375, Japan
Author contributions: Yamauchi H performed research and wrote the paper; Kida M, Imaizumi H, Okuwaki K, Miyazawa S, Iwai T and Koizumi W contributed critical revision of the manuscript for important intellectual content.
Conflict-of-interest: The authors declare no conflict of interest.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Hiroshi Yamauchi, MD, Department of Gastroenterology, Kitasato University Hospital, 1-15-1 Kitasato, Minami-ku, Sagamihara, Kanagawa 252-0375, Japan. yhiroshi@kitasato-u.ac.jp
Telephone: +81-42-7788111 Fax: +81-42-7788390
Received: January 19, 2015
Peer-review started: January 20, 2015
First decision: March 10, 2015
Revised: March 24, 2015
Accepted: May 7, 2015
Article in press: May 7, 2015
Published online: June 7, 2015
Abstract

Endoscopic retrograde cholangiopancreatography (ERCP) remains challenging in patients who have undergone surgical reconstruction of the intestine. Recently, many studies have reported that balloon-enteroscope-assisted ERCP (BEA-ERCP) is a safe and effective procedure. However, further improvements in outcomes and the development of simplified procedures are required. Percutaneous treatment, Laparoscopy-assisted ERCP, endoscopic ultrasound-guided anterograde intervention, and open surgery are effective treatments. However, treatment should be noninvasive, effective, and safe. We believe that these procedures should be performed only in difficult-to-treat patients because of many potential complications. BEA-ERCP still requires high expertise-level techniques and is far from a routinely performed procedure. Various techniques have been proposed to facilitate scope insertion (insertion with percutaneous transhepatic biliary drainage (PTBD) rendezvous technique, Short type single-balloon enteroscopes with passive bending section, Intraluminal injection of indigo carmine, CO2 inflation guidance), cannulation (PTBD or percutaneous transgallbladder drainage rendezvous technique, Dilation using screw drill, Rendezvous technique combining DBE with a cholangioscope, endoscopic ultrasound-guided rendezvous technique), and treatment (overtube-assisted technique, Short type balloon enteroscopes) during BEA-ERCP. The use of these techniques may allow treatment to be performed by BEA-ERCP in many patients. A standard procedure for ERCP yet to be established for patients with a reconstructed intestine. At present, BEA-ERCP is considered the safest and most effective procedure and is therefore likely to be recommended as first-line treatment. In this article, we discuss the current status of BEA-ERCP in patients with surgically altered gastrointestinal anatomy.

Keywords: Balloon enteroscopy, Endoscopic retrograde cholangiopancreatography, Altered gastrointestinal anatomy, Balloon-enteroscope-assisted endoscopic retrograde cholangiopancreatography

Core tip: Endoscopic retrograde cholangiopancreatography (ERCP) remains challenging in patients with reconstructed intestine. Recently, many studies have reported that balloon-enteroscope-assisted ERCP (BEA-ERCP) is a safe and effective procedure. However, further improvements in outcomes and the development of simplified procedures are required. Various techniques have been proposed to facilitate scope insertion, cannulation, and treatment during BEA-ERCP. We discuss the current status of BEA-ERCP in patients with surgically altered gastrointestinal anatomy and introduce the techniques that are considered necessary in order to improve the outcomes.