Division of Gastroenterology and Hepatology, University of Colorado Anschutz Medical Campus, Aurora, CO 80045, USA.
Gastrointest Endosc. 2013 Apr;77(4):593-600. doi: 10.1016/j.gie.2012.10.015. Epub 2013 Jan 3.
Data on overtube-assisted enteroscopy to facilitate ERCP in patients with surgically altered pancreaticobiliary anatomy, or long-limb surgical bypass, is limited.
To evaluate and compare ERCP success by using single-balloon (SBE), double-balloon (DBE), or rotational overtube enteroscopy.
Consecutive patients identified retrospectively.
Eight U.S. referral centers.
Long-limb surgical bypass patients with suspected pancreaticobiliary diseases.
Overtube-assisted enteroscopy ERCP.
Enteroscopy success: visualizing the pancreaticobiliary-enteric anastomosis or papilla. ERCP success: completing the intended pancreaticobiliary intervention. Clinical success: greater than 50% reduction in abdominal pain or level of hepatic enzyme elevations or resolution of jaundice.
From January 2008 through October 2009, 129 patients had 180 enteroscopy-ERCPs. Anatomy was Roux-en-Y: gastric bypass (n = 63), hepaticojejunostomy (n = 45), postgastrectomy (n = 6), Whipple procedure (n = 10), and other (n = 5). ERCP success was 81 of 129 (63%). Enteroscopy success: 92 of 129 (71%), of whom 81 of 92 (88%) achieved ERCP success. Reasons for ERCP failure (n = 48): afferent limb entered but pancreaticobiliary anastomosis and/or papilla not reached (n = 23), cannulation failure (n = 11), afferent limb angulation (n = 8), and jejunojejunostomy not identified (n = 6). Select interventions: anastomotic stricturoplasty (cautery ± dilation, n = 16), stone removal (n = 21), stent (n = 25), and direct cholangioscopy (n = 11). ERCP success rates were similar between Roux-en-Y gastric bypass and other long-limb surgical bypass and among SBE, DBE, and rotational overtube enteroscopy. Complications were 16 of 129, 12.4%.
Retrospective study.
(1) ERCP is successful in nearly two-thirds of long-limb surgical bypass patients and in 88% when the papilla or pancreaticobiliary-enteric anastomosis is reached. (2) Enteroscopy success in long-limb surgical bypass is similar among SBE, DBE, and rotational overtube enteroscopy methods. (3) Referral of long-limb surgical bypass patients who require ERCP to high-volume institutions may be considered before more invasive percutaneous or surgical alternatives.
经内镜逆行胰胆管造影术（ERCP）中使用辅助外套管以辅助进镜来完成在胆胰管解剖结构改变或长段肠旁路手术患者中的操作，目前仅有少量数据支持。
评估并比较单气囊（SBE）、双气囊（DBE）和旋转外套管辅助进镜在 ERCP 中的应用效果。
回顾性连续病例系列研究。
美国 8 家转诊中心。
长段肠旁路手术且怀疑患有胆胰疾病的患者。
外套管辅助进镜下 ERCP。
进镜成功：观察到胆胰肠吻合口或乳头。ERCP 成功：完成预期的胆胰介入治疗。临床成功：腹痛、肝酶水平升高或黄疸减轻 50%以上。
2008 年 1 月至 2009 年 10 月，129 例患者接受了 180 次经内镜逆行胰胆管造影术。解剖结构为 Roux-en-Y：胃旁路（n=63）、肝肠吻合术（n=45）、胃切除术后（n=6）、Whipple 手术（n=10）和其他（n=5）。ERCP 成功率为 129 例中的 81 例（63%）。进镜成功：129 例中的 92 例（71%），其中 92 例中的 81 例（88%）实现了 ERCP 成功。ERCP 失败的原因（n=48）：进入输入襻但未到达胆胰吻合口和/或乳头（n=23）、插管失败（n=11）、输入襻成角（n=8）和无法识别空肠空肠吻合口（n=6）。选择的介入治疗：吻合口狭窄扩张（电切术+扩张术，n=16）、取石（n=21）、支架置入（n=25）和直接胆管镜检查（n=11）。Roux-en-Y 胃旁路和其他长段肠旁路手术之间以及 SBE、DBE 和旋转外套管辅助进镜之间的 ERCP 成功率相似。并发症 129 例中有 16 例（12.4%）。
回顾性研究。
（1）近三分之二的长段肠旁路手术患者的 ERCP 是成功的，当到达乳头或胆胰肠吻合口时，成功率为 88%。（2）在 SBE、DBE 和旋转外套管辅助进镜方法中，长段肠旁路手术的进镜成功率相似。（3）对于需要 ERCP 的长段肠旁路手术患者，在考虑更具侵袭性的经皮或手术替代方法之前，可考虑将其转至高容量机构。
