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
Processing time: 87 Days and 21.1 Hours
ARTICLE HIGHLIGHTS
Research background

Double-balloon endoscopic retrograde cholangiography (DBERC) has been widely used for pancreatobiliary diseases after reconstruction in gastrointestinal surgery, but sometimes it is complicating.

Research motivation

The accurate selection of the route at the anastomosis branch is one of the most important factors for the success of DBERC. We used carbon dioxide insufflation enterography (CDE) for selecting the route.

Research objectives

The aim of this study was to determine the accuracy of CDE at the branch for selecting the correct route during DBERC.

Research methods

Route selection via two methods (visual observation and CDE) was performed in each patient in DBERC. We determined the correct rate of route selection using CDE. The primary endpoint was the correct rate of CDE for selection of the route to the target. Secondary endpoints were the comparison of correct rate between visual observation and CDE around the anastomosis and examination times.

Research results

We enrolled 52 consecutive patients scheduled for DBERC at our institution from June 2015 to November 2017. We were able to reach the target in 50/52 patients. 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%).

Research conclusions

CDE was able to accurately select the route at the anastomosis in patients with gastrointestinal reconstruction who are undergoing DBERC.

Research perspectives

Using CDE, DBERC will be performed safely and easily for patients who underwent any gastrointestinal reconstruction. A randomized, comparative study between CDE and visual observation for the proper route selection is necessary.