Department of Medicine 1, University of Erlangen-Nürnberg, Ulmenweg 18, 91054 Erlangen, Germany.
World J Gastroenterol. 2011 May 14;17(18):2302-14. doi: 10.3748/wjg.v17.i18.2302.
To evaluate double balloon enteroscopy (DBE) in post-surgical patients to perform endoscopic retrograde cholangiopancreatography (ERCP) and interventions.
In 37 post-surgical patients, a stepwise approach was performed to reach normal papilla or enteral anastomoses of the biliary tract/pancreas. When conventional endoscopy failed, DBE-based ERCP was performed and standard parameters for DBE, ERCP and interventions were recorded.
Push-enteroscopy (overall, 16 procedures) reached enteral anastomoses only in six out of 37 post-surgical patients (16.2%). DBE achieved a high rate of luminal access to the biliary tract in 23 of the remaining 31 patients (74.1%) and to the pancreatic duct (three patients). Among all DBE-based ERCPs (86 procedures), 21/23 patients (91.3%) were successfully treated. Interventions included ostium incision or papillotomy in 6/23 (26%) and 7/23 patients (30.4%), respectively. Biliary endoprosthesis insertion and regular exchange was achieved in 17/23 (73.9%) and 7/23 patients (30.4%), respectively. Furthermore, bile duct stone extraction as well as ostium and papillary dilation were performed in 5/23 (21.7%) and 3/23 patients (13.0%), respectively. Complications during DBE-based procedures were bleeding (1.1%), perforation (2.3%) and pancreatitis (2.3%), and minor complications occurred in up to 19.1%.
The appropriate use of DBE yields a high rate of luminal access to papilla or enteral anastomoses in more than two-thirds of post-surgical patients, allowing important successful endoscopic therapeutic interventions.
评估双气囊小肠镜（DBE）在外科手术后患者中行内镜逆行胰胆管造影（ERCP）和介入治疗的作用。
对 37 例外科手术后患者采用逐步方法到达正常乳头或胆道/胰腺肠吻合口。当常规内镜检查失败时，行 DBE 引导的 ERCP，并记录 DBE、ERCP 和介入治疗的标准参数。
推进式小肠镜（总共 16 例）仅在 37 例外科手术后患者中的 6 例（16.2%）中到达肠吻合口。DBE 使 31 例中其余 23 例（74.1%）患者胆道和胰腺导管（3 例）获得很高的管腔入路率。在所有基于 DBE 的 ERCP 中（86 例），21/23 例（91.3%）患者得到成功治疗。介入治疗包括切开胆管开口或乳头切开，分别在 6/23（26%）和 7/23 例（30.4%）患者中进行。分别在 17/23（73.9%）和 7/23 例（30.4%）患者中实现胆管内支架置入和定期更换。此外，5/23（21.7%）和 3/23 例（13.0%）患者行胆管结石取出术以及胆管开口和乳头扩张术。DBE 引导下操作的并发症包括出血（1.1%）、穿孔（2.3%）和胰腺炎（2.3%），轻微并发症发生率高达 19.1%。
适当使用 DBE 可使三分之二以上的外科手术后患者获得较高的乳头或肠吻合口内腔通道率，从而实现重要的成功内镜治疗干预。
