Retrospective Study
Copyright ©The Author(s) 2015. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastrointest Endosc. Mar 16, 2015; 7(3): 278-282
Published online Mar 16, 2015. doi: 10.4253/wjge.v7.i3.278
Rotational assisted endoscopic retrograde cholangiopancreatography in patients with reconstructive gastrointestinal surgical anatomy
Majed El Zouhairi, James B Watson, Svetang V Desai, David K Swartz, Alejandra Castillo-Roth, Mahfuzul Haque, Paul S Jowell, Malcolm S Branch, Rebecca A Burbridge
Majed El Zouhairi, James B Watson, Svetang V Desai, David K Swartz, Mahfuzul Haque, Paul S Jowell, Malcolm S Branch, Rebecca A Burbridge, Division of Gastroenterology, Duke University Medical Center, Durham, NC 27710, United States
Alejandra Castillo-Roth, Northern New Mexico Gastroenterology Associates, Santa Fe, NM 87505, United States
Author contributions: All authors helped equally in: Substantial contributions to the conception or design of the work including the acquisition, analysis, and interpretation of data for the work; drafting the work or revising it critically for important intellectual content; final approval of the version to be published; and agreement to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved.
Ethics approval: The study was reviewed and approved by the Duke University Health System (DUHS) Institutional Review Board (IRB).
Informed consent: The study is a retrospective review. Only general demographic information in regards to the patients was obtained. No informed consent was obtained from involved persons. A waiver of consent was filled and approved by DUHS IRB.
Conflict-of-interest: All authors declare that there is no conflict of interest.
Data sharing: No additional data are available.
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: Majed El Zouhairi, MD, Division of Gastroenterology, Duke University Medical Center, Box 3913, 03142 Orange Zone, Durham, NC 27710, United States. majed.elzouhairi@dm.duke.edu
Telephone: +1-919-6842819 Fax: +1-919-6848857
Received: August 15, 2014
Peer-review started: August 15, 2014
First decision: September 16, 2014
Revised: January 20, 2015
Accepted: February 4, 2015
Article in press: February 9, 2015
Published online: March 16, 2015
Processing time: 217 Days and 7.9 Hours
Abstract

AIM: To evaluate the success rates of performing therapy utilizing a rotational assisted enteroscopy device in endoscopic retrograde cholangiopancreatography (ERCP) in surgically altered anatomy patients.

METHODS: Between June 1, 2009 and November 8, 2012, we performed 42 ERCPs with the use of rotational enteroscopy for patients with altered anatomy (39 with gastric bypass Roux-en-Y, 2 with Billroth II gastrectomy, and 1 with hepaticojejunostomy associated with liver transplant). The indications for ERCP were: choledocholithiasis: 13 of 42 (30.9%), biliary obstruction suggested on imaging: 20 of 42 (47.6%), suspected sphincter of Oddi dysfunction: 4 of 42 (9.5%), abnormal liver enzymes: 1 of 42 (2.4%), ascending cholangitis: 2 of 42 (4.8%), and bile leak: 2 of 42 (4.8%). All procedures were completed with the Olympus SIF-Q180 enteroscope and the Endo-Ease Discovery SB overtube produced by Spirus Medical.

RESULTS: Successful visualization of the major ampulla was accomplished in 32 of 42 procedures (76.2%). Cannulation of the bile duct was successful in 26 of 32 procedures reaching the major ampulla (81.3%). Successful therapeutic intervention was completed in 24 of 26 procedures in which the bile duct was cannulated (92.3%). The overall intention to treat success rate was 64.3%. In terms of cannulation success, the intention to treat success rate was 61.5%. Ten out of forty two patients (23.8%) required admission to the hospital after procedure for abdominal pain and nausea, and 3 of those 10 patients (7.1%) had a diagnosis of post-ERCP pancreatitis. The average hospital stay was 3 d.

CONCLUSION: It is reasonable to consider an attempt at rotational assisted ERCP prior to a surgical intervention to alleviate biliary complications in patients with altered surgical anatomy.

Keywords: Gastric bypass; Gastrostomy; Cholangiopancreatography; Endoscopic retrograde; Double-Balloon enteroscopy; Ampulla of vater; Sphincterotomy; Endoscopic; Pancreatitis; Retrospective studies

Core tip: This manuscript shows a single tertiary care center experience in a large number of patients with surgically altered anatomy by evaluating the success rates of reaching the major ampulla, cannulating the bile duct, and subsequently performing therapy utilizing a rotational assisted enteroscopy device in an endoscopic retrograde cholangiopancreatography. This study will also determine the associated morbidity, mortality, and length of hospitalization associated with the procedures. Given our institutions success rates and minimal complication profile, specialized centers could consider this approach in this rapidly growing population. This will be instrumental in the development of new therapeutic options for patients suffering from this condition.