双气囊内镜可提高 Billroth II 式胃切除术后患者的 ERCP 成功率。
Double balloon endoscopy increases the ERCP success rate in patients with a history of Billroth II gastrectomy.
机构信息
Division of Digestive Therapeutic Endoscopy, Department of Gastroenterology and Hepatology, Chang Gung Memorial Hospital, Taoyuan 333, Taiwan, China.
出版信息
World J Gastroenterol. 2010 Sep 28;16(36):4594-8. doi: 10.3748/wjg.v16.i36.4594.
AIM
To evaluate the effect of double balloon endoscope (DBE) on the endoscopic retrograde cholangiopancreatography (ERCP) success rate in patients with a history of Billroth II (B II) gastrectomy.
METHODS
From April 2006 to March 2007, 32 patients with a B II gastrectomy underwent 34 ERCP attempts. In all cases, the ERCP procedures were started using a duodenoscope. If intubation of the afferent loop or reaching the papilla failed, we changed to DBE for the ERCP procedure (DBE-ERCP). We assessed the success rate of afferent loop intubation, reaching the major papilla, selective cannulation, possibility of therapeutic approaches, procedure-related complications, and the overall success rate.
RESULTS
Among the 32 patients with a history of B II gastrectomy, the duodenoscope was successfully passed up to the papilla in 22 patients (69%), and cannulation was successfully performed in 20 patients (63%). Six patients (2 with failure in afferent loop intubation and 4 with failure in reaching the papilla) underwent DBE-ERCP. The DBE reached the papilla in all the 6 patients (100%) and selective cannulation was successful in 5 patients (83%). Four patients (67%) who had common bile duct stones were successfully treated. One patient underwent diagnostic ERCP only and the other one, in whom selective cannulation failed, was diagnosed with papilla cancer proven by biopsy. There were no complications related to the DBE. The overall ERCP success rate increased to 88% (28/32).
CONCLUSION
The overall ERCP success rate increases with DBE in patients with a previous B II gastrectomy.
目的
评估双气囊内镜（DBE）在有 Billroth II（B II）胃切除史的患者中行内镜逆行胰胆管造影术（ERCP）的成功率。
方法
从 2006 年 4 月至 2007 年 3 月，对 32 例 B II 胃切除术后患者进行了 34 次 ERCP 尝试。在所有病例中，ERCP 操作均从十二指肠镜开始。如果输入襻插管或到达乳头失败，我们将改为 DBE 进行 ERCP 操作（DBE-ERCP）。我们评估了输入襻插管、到达主乳头、选择性插管、治疗方法的可能性、与操作相关的并发症以及总体成功率。
结果
在 32 例有 B II 胃切除史的患者中，22 例（69%）十二指肠镜成功到达乳头，20 例（63%）成功进行了插管。6 例（2 例输入襻插管失败，4 例到达乳头失败）进行了 DBE-ERCP。6 例患者（100%）DBE 均到达乳头，5 例（83%）选择性插管成功。4 例（67%）胆总管结石患者得到成功治疗。1 例仅行诊断性 ERCP，1 例选择性插管失败，经活检证实为乳头癌。DBE 无相关并发症。总体 ERCP 成功率提高至 88%（28/32）。
结论
在有 B II 胃切除史的患者中，DBE 可提高总体 ERCP 成功率。
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