Division of Gastroenterology and Hepatology, Department of Medicine, University of Virginia Health System, Charlottesville, Virginia 22908, USA.
Gastrointest Endosc. 2010 Mar;71(3):641-9. doi: 10.1016/j.gie.2009.10.051.
In patients with surgically altered anatomy, ERCP is often unsuccessful. Single-balloon enteroscopy (SBE) enables deep intubation of the small bowel, permitting diagnostic and therapeutic ERCP in this subset of patients.
To determine the effectiveness of SBE in performing endoscopic retrograde cholangiography (ERC) in patients with surgically altered anatomy.
Case series.
Large quaternary-care center.
Thirteen patients (11 women) underwent 16 SBE procedures with ERCP. Patient anatomy consisted of Whipple (n = 3), hepaticojejunostomy (n = 3), Billroth II (n = 1), and Roux-en-Y (n = 9).
Patients with surgically altered anatomy in whom standard ERCP techniques had failed or were not possible underwent ERC by using SBE with initial therapeutic intent.
Success rates of diagnostic ERC and therapeutic ERC in those patients who required biliary intervention. Procedure-related complications were also assessed.
Diagnostic ERC was successful 12 (92.3%) of 13 patients and in 13 (81.3%) of 16 cases. Therapeutic ERC was required in 10 patients in whom diagnostic ERC was first accomplished, and therapeutic ERC was successful in 9 (90%) of 10 patients. Biliary interventions included balloon dilation (n = 4), stone extraction (n = 2), sphincterotomy (n = 4), removal of a surgically placed stent (n = 3), and stenting (n = 2). Two patients developed pancreatitis after therapeutic ERC. Median follow-up was 53 days (range 22-522 days). Overall procedural success in an intent-to-treat analysis by case was 75%.
Single-center experience.
SBE enables diagnostic and therapeutic ERC in most patients with altered anatomy. SBE-assisted therapeutic ERC may be associated with an increased risk of pancreatitis. Improvement of the available equipment is necessary to perform more efficient and effective biliary interventions.
在解剖结构改变的患者中，ERCP 往往不成功。单球囊小肠镜（SBE）可实现小肠的深部插管，使这部分患者能够进行诊断和治疗性 ERCP。
确定 SBE 在具有解剖结构改变的患者中进行内镜逆行胰胆管造影术（ERC）的有效性。
病例系列。
大型四级保健中心。
13 名患者（11 名女性）接受了 16 次 SBE 联合 ERCP 检查。患者的解剖结构包括 Whipple（n=3）、胆肠吻合术（n=3）、Billroth II 术（n=1）和 Roux-en-Y 术（n=9）。
在标准 ERCP 技术失败或不可能进行的解剖结构改变的患者中，最初以治疗为目的进行 SBE 联合 ERC。
需要胆道介入的患者中诊断性 ERC 和治疗性 ERC 的成功率。还评估了与手术相关的并发症。
13 例患者中的 12 例（92.3%）和 16 例中的 13 例（81.3%）成功进行了诊断性 ERC。10 例患者在完成诊断性 ERC 后需要进行治疗性 ERC，其中 9 例（90%）成功。胆道介入治疗包括球囊扩张（n=4）、取石（n=2）、括约肌切开术（n=4）、取出手术放置的支架（n=3）和支架置入（n=2）。2 例患者在治疗性 ERC 后发生胰腺炎。中位随访时间为 53 天（范围 22-522 天）。按病例进行意向治疗分析的总体手术成功率为 75%。
单中心经验。
SBE 可使大多数解剖结构改变的患者进行诊断和治疗性 ERC。SBE 辅助治疗性 ERC 可能与胰腺炎风险增加有关。需要改进现有设备以进行更有效和高效的胆道介入治疗。
