Pohl J, May A, Aschmoneit I, Ell C
Department of Gastroenterology, Dr-Horst-Schmidt-Klinik, (Medical School of the Johannes-Gutenberg-University of Mainz), Wiesbaden, Germany.
Z Gastroenterol. 2009 Feb;47(2):215-9. doi: 10.1055/s-2008-1027800. Epub 2009 Feb 5.
Choledochojejunal anastomoses with Roux-en-Y reconstruction excludes the biliary tract from conventional endoscopic retrograde cholangiography (ERC) with standard endoscopes due to the length of the interposed small bowel segment. Double-balloon enteroscopy (DBE) facilitates deep insertion into the small bowel and may be used to perform ERC in these patients. In the present case series we report our experience with diagnostic and therapeutic double-balloon ERC in patients with choledochojejunostomy to a long Roux-en-Y loop previously unavailable for standard length endoscopes.
Between December 2004 and May 2008 15 patients (mean age: 60.2 years) with choledochojejunal anastomosis underwent a total of 25 DBE-ERC procedures.
Cannulation of the bile ducts was achieved in 22 / 25 procedures (84 %). Twenty-one therapeutic interventions, including stone removal, biliary duct dilation, stent placement and removal of previously placed stents were performed during 16 procedures in 8 patients. The mean total duration time of the procedures was 74.6 +/- 25.0 minutes. Postinterventional self-limiting fever occurred after 4 procedures in 3 patients with cholangitis. After therapeutic interventions all patients had a significant drop of bilirubin levels and all except one patient were free of complaints (follow-up 10.4 +/- 8.6 months).
The DBE system permits diagnostic and therapeutic ERC in surgically modified anatomy, previously unavailable for endoluminal access. In our experience this procedure is safe and has a high success rate with a favourable patient outcome.
由于插入的小肠段长度，采用Roux-en-Y重建的胆总管空肠吻合术使常规内镜逆行胆管造影（ERC）使用标准内镜无法进入胆道。双气囊小肠镜（DBE）有助于深入小肠，可用于这些患者的ERC。在本病例系列中，我们报告了对先前标准长度内镜无法到达的长Roux-en-Y袢胆总管空肠吻合术患者进行诊断性和治疗性双气囊ERC的经验。
2004年12月至2008年5月，15例（平均年龄：60.2岁）胆总管空肠吻合术患者共接受了25次双气囊小肠镜引导下的ERC操作。
25次操作中有22次（84%）成功插管进入胆管。在8例患者的16次操作中进行了21次治疗干预，包括取石、胆管扩张、支架置入和取出先前置入的支架。操作的平均总持续时间为74.6±25.0分钟。3例胆管炎患者在4次操作后出现介入后自限性发热。治疗干预后，所有患者胆红素水平均显著下降，除1例患者外，所有患者均无不适主诉（随访10.4±8.6个月）。
双气囊小肠镜系统允许在手术改变的解剖结构中进行诊断性和治疗性ERC，这是以前腔内通路无法实现的。根据我们的经验，该操作安全，成功率高，患者预后良好。
