Takano S, Fukasawa M, Shindo H, Takahashi E, Hirose S, Fukasawa Y, Kawakami S, Hayakawa H, Yokomichi H, Kadokura M, Sato T, Enomoto N. Risk factors for perforation during endoscopic retrograde cholangiopancreatography in post-reconstruction intestinal tract. World J Clin Cases 2019; 7(1): 10-18 [PMID: 30637248 DOI: 10.12998/wjcc.v7.i1.10]
Corresponding Author of This Article
Mitsuharu Fukasawa, MD, PhD, Lecturer, First Department of Internal Medicine, Faculty of Medicine, University of Yamanashi, 1110, Shimokato, Chuo, Yamanashi 409-3898, Japan. fmitsu@yamanashi.ac.jp
Research Domain of This Article
Gastroenterology & Hepatology
Article-Type of This Article
Retrospective Cohort Study
Open-Access Policy of This Article
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/
Shinichi Takano, Mitsuharu Fukasawa, Hiroko Shindo, Ei Takahashi, Sumio Hirose, Yoshimitsu Fukasawa, Satoshi Kawakami, Hiroshi Hayakawa, Makoto Kadokura, Tadashi Sato, Nobuyuki Enomoto, First Department of Internal Medicine, Faculty of Medicine, University of Yamanashi, Yamanashi 409-3898, Japan
Hiroshi Yokomichi, Department of Health Sciences, Interdisciplinary Graduate School and Engineering, University of Yamanashi, Yamanashi 409-3898, Japan
Author contributions: Takano S designed and conducted the research and wrote the paper; Fukasawa M designed the research and supervised the report; Shindo H, Takahashi E, Hirose S, Fukasawa Y, Kawakami S, Hayakawa H, and Kadokura M provided clinical advice; Hiroshi Yokomichi checked statistical methods; Sato T and Enomoto N supervised the report.
Institutional review board statement: This retrospective study was approved by the ethics committee of Yamanashi University Hospital.
Informed consent statement: The requirement for written informed consent was waived by the ethics committee of our institution because the study was a retrospective data analysis. Appropriate consideration was given to patient risk, privacy, welfare, and rights.
Conflict-of-interest statement: All authors report no financial conflicts of interest related to this article.
Data sharing statement: 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/
Corresponding author: Mitsuharu Fukasawa, MD, PhD, Lecturer, First Department of Internal Medicine, Faculty of Medicine, University of Yamanashi, 1110, Shimokato, Chuo, Yamanashi 409-3898, Japan. fmitsu@yamanashi.ac.jp
Telephone: +81-55-273-9584 Fax: +81-55-273-6748
Received: October 27, 2018 Peer-review started: October 29, 2018 First decision: November 22, 2018 Revised: December 16, 2018 Accepted: December 21, 2018 Article in press: December 21, 2018 Published online: January 6, 2019 Processing time: 69 Days and 9.3 Hours
ARTICLE HIGHLIGHTS
Research background
The development of deep enteroscopies, such as double-balloon enteroscopy (DBE) and single-balloon enteroscopy has enabled performing endoscopic retrograde cholangiopancreatography (ERCP) in patients with surgically altered anatomy, such as Billroth-II and Roux-en-Y reconstructions.
Research motivation
Surgically altered anatomy is a risk factor for perforations, not only in ERCP-related procedures, but also in DBE-related procedures. However, no report has elucidated the risk factors for perforation by type of surgical anatomy and detailed operative information.
Research objectives
The main objective of this study is to identify ERCP-related risk factors for perforation in patients with surgically altered anatomy.
Research methods
Medical records of 187 patients with surgically altered anatomy who underwent ERCP at our institution between April 2009 and December 2017 were retrospectively reviewed and analyzed to identify risk factors for perforation.
Research results
All patients who had undergone perforation were with Billroth-II reconstruction; further analysis in these patients revealed loop-shaped insertion of the scope to be a significant risk for perforation.
Research conclusions
The new findings of this study are that risk factors for perforation during ERCP in patients with surgically altered anatomy were Billroth-II reconstruction and looping of the scope during Billroth-II procedure.
Research perspectives
Our findings suggest that, in patients with Billroth-II reconstruction, reaching the target site with the scope in a loop configuration carried a risk of perforation; therefore, it should be performed carefully.
