Prospective Study
Copyright ©The Author(s) 2020. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastroenterol. Nov 14, 2020; 26(42): 6669-6678
Published online Nov 14, 2020. doi: 10.3748/wjg.v26.i42.6669
Accuracy of carbon dioxide insufflation for endoscopic retrograde cholangiopancreatography using double-balloon endoscopy
Yoshiki Niwa, Masanao Nakamura, Hiroki Kawashima, Takeshi Yamamura, Keiko Maeda, Tsunaki Sawada, Yasuyuki Mizutani, Eri Ishikawa, Takuya Ishikawa, Naomi Kakushima, Kazuhiro Furukawa, Eizaburo Ohno, Takashi Honda, Masatoshi Ishigami, Mitsuhiro Fujishiro
Yoshiki Niwa, Masanao Nakamura, Takeshi Yamamura, Yasuyuki Mizutani, Eri Ishikawa, Takuya Ishikawa, Naomi Kakushima, Kazuhiro Furukawa, Eizaburo Ohno, Takashi Honda, Masatoshi Ishigami, Mitsuhiro Fujishiro, Department of Gastroenterology and Hepatology, Nagoya University Graduate School of Medicine, Nagoya 466-8560, Japan
Hiroki Kawashima, Keiko Maeda, Tsunaki Sawada, Department of Endoscopy, Nagoya University Hospital, Nagoya 466-8560, Japan
Author contributions: Niwa Y and Nakamura M contributed to the conception and design; Niwa Y, Nakamura M, Kawashima H and Ishikawa T, Kakushima N contributed to the analysis and interpretation of the data; Niwa Y drafted the article; Ohno E, Ishikawa E, Yamamura T, Maeda K, Sawada T, Honda T, Mizutani Y, Furukawa K, and Ishigami M contributed to critical revision of the article for important intellectual content; Nakamura M and Yamamura T contributed to Statistical analysis; Fujishiro M made final approval of the article; all authors have read and approve the final manuscript.
Institutional review board statement: The study was reviewed and approved by the Ethics Committee of Nagoya University Hospital.
Clinical trial registration statement: The study was registered in the University Hospital Medical Information Network and in a clinical trial registry (UMIN000018357).
Informed consent statement: All study participants provided informed written consent prior to study enrollment.
Conflict-of-interest statement: Department of Gastroenterology and Hepatology, Nagoya University Graduate School of Medicine is receiving a scholarship donation from FUJIFILM. There are no additional conflict of interest that would pertain to the content of this study.
Data sharing statement: No additional data are available.
CONSORT 2010 statement: The authors have read the CONSORT 2010 statement, and the manuscript was prepared and revised according to the CONSORT 2010 statement.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (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/
Corresponding author: Masanao Nakamura, MD, PhD, Lecturer, Department of Gastroenterology and Hepatology, Nagoya University Graduate School of Medicine, 65 Tsurumai-cho, Showa-ku, Nagoya 466-8560, Japan. makamura@med.nagoya-u.ac.jp
Received: August 17, 2020
Peer-review started: August 17, 2020
First decision: September 12, 2020
Revised: September 14, 2020
Accepted: September 23, 2020
Article in press: September 23, 2020
Published online: November 14, 2020
Abstract
BACKGROUND

Retrograde cholangiopancreatography using double-balloon endoscopic retrograde cholangiography (DBERC) is a valuable technique to treat biliary stone and jejunobiliary anastomotic stenosis in patients with altered gastrointestinal anatomy. The accurate selection of the route at the anastomosis branch is one of the most important factors in reaching the target in a timely manner. 

AIM

To determine the accuracy of carbon dioxide insufflation enterography (CDE) at the branch for selecting the correct route during DBERC.

METHODS

We enrolled 52 consecutive patients scheduled for DBERC at our institution from June 2015 to November 2017. Route selection via two methods (visual observation and CDE) was performed in each patient. We determined the correct rate of route selection using CDE.

RESULTS

Thirty-three patients had a jejunojejunal anastomosis and 19 patients had a gastrojejunal anastomosis. The therapeutic target region was reached in 50 patients. The mean procedure times from the teeth to the target (total insertion time), from the teeth to the branch, and from the branch to the target, and the mean total examination time were 15.2, 5.0, 8.2, and 60.3 min, respectively. The rate of correct route selection using visual observation and CDE were 36/52 (69.2%) and 48/52 (92.3%), respectively (P = 0.002). The rate of correct route selection using CDE in patients with a jejunojejunal anastomosis was 29/33 (87.8%), and the rate in patients with a gastrojejunal anastomosis was 19/19 (100%).

CONCLUSION

CDE is helpful in selecting the route at the branch in the anastomosis for more timely access to the target in patients with altered gastrointestinal anatomy undergoing DBERC.

Keywords: Retrograde cholangiopancreatography, Double-balloon endoscopy, Carbon dioxide insufflation, Anastomosis, Accuracy, Prospective study

Core Tip: Carbon dioxide insufflation enterography (CDE) may be useful for selecting route at branch in patients with altered gastrointestinal anatomy in double-balloon endoscopy. The endoscopist inserts the tip of the endoscope into one of the two tracts at the branch and insufflate carbon dioxide with an obstruction created by the inflation of an endoscopic balloon. Fluoroscopy is used to determine the direction of carbon dioxide flow. This prospective study evaluated the usefulness of CDE during double-balloon endoscopic retrograde cholangiography in patients with altered gastrointestinal anatomy by prospectively investigating the accuracy of route selection using CDE at the branch of the anastomosis. The mean procedure times from the teeth to the target (total insertion time), from the teeth to the branch, and from the branch to the target, and the mean total examination time were 15.2, 5.0, 8.2, and 60.3 min, respectively. The rate of correct route selection using CDE in patients with a jejunojejunal anastomosis was 29/33 (87.8%), and the rate in patients with a gastrojejunal anastomosis was 19/19 (100%).