Department of Medicine, Mayo Clinic, Rochester, Minnesota, USA.
Gastrointest Endosc. 2013 Apr;77(4):568-77. doi: 10.1016/j.gie.2012.11.031. Epub 2013 Jan 29.
Endoscopic retrograde cholangiography (ERC) is technically challenging in liver transplant patients with Roux-en-Y biliary anastomosis. The optimal endoscope for such cases remains unknown.
Compare efficacy and safety of performing ERC in liver transplant patients with Roux-en-Y biliary anastomosis by using an adult colonoscope (AC), a pediatric colonoscope (PC), and a single-balloon enteroscope (SBE).
Retrospective chart review.
Tertiary-care referral center.
Liver transplant patients with Roux-en-Y biliary anastomoses.
ERC with AC, PC, and SBE.
Rates of reaching the afferent limb and biliary anastomosis; rates of cannulation; rates of diagnostic, therapeutic, and procedural success; and number of adverse events.
Ninety patients underwent 199 ERCs from 2002 to 2012; 86 with an AC, 55 with a PC, and 58 with an SBE. Biliary cannulation and diagnostic, therapeutic, and procedural success rates were all significantly higher with an SBE than with a PC. Among patients undergoing the initial ERC, no statistical difference was found among SBE, the PC, and an AC. However, the rate of procedural success with SBE during initial ERC over the last 4 years has increased. Of 25 total failures with ACs, exchange for SBEs resulted in procedural success in 4 of 4 attempts. Of 22 failures with a PC, exchange for an SBE resulted in success in 3 of 4 cases. Of 4 failures with SBE exchange in 6 cases (4 to AC, 2 to PC), SBE resulted in success in only 1. No adverse events occurred directly related to type of endoscope.
Retrospective study, single center, lack of standardized approach to selection of endoscopes, uncontrolled variables (general anesthesia, learning curve).
In liver transplant patients with Roux-en-Y anatomy, rates of biliary cannulation, therapeutic success, and procedural success are higher with use of an SBE than with a PC and tend to be higher compared with use of an AC among the overall cohort. Use of an SBE and procedural success rates with SBEs have increased over the last 4 years. Failed cases with either an AC or PC can be completed if exchanged for an SBE.
对于接受 Roux-en-Y 胆肠吻合术的肝移植患者，内镜逆行胰胆管造影（ERC）在技术上具有挑战性。对于此类病例，最佳的内镜仍不清楚。
比较使用成人结肠镜（AC）、小儿结肠镜（PC）和单球囊小肠镜（SBE）进行肝移植患者 Roux-en-Y 胆肠吻合术的 ERC 的疗效和安全性。
回顾性图表审查。
三级转诊中心。
接受 Roux-en-Y 胆肠吻合术的肝移植患者。
使用 AC、PC 和 SBE 进行 ERC。
到达输入襻和胆肠吻合口的比率；插管率；诊断、治疗和程序成功率；以及不良事件的数量。
2002 年至 2012 年，90 例患者进行了 199 次 ERC，其中 86 次使用 AC，55 次使用 PC，58 次使用 SBE。与 PC 相比，SBE 显著提高了胆管插管和诊断、治疗及程序成功率。在首次 ERC 中，SBE、PC 和 AC 之间无统计学差异。然而，过去 4 年，SBE 首次 ERC 的程序成功率有所提高。25 例 AC 总失败中，4 例 4 次尝试交换为 SBE 获得成功。22 例 PC 失败中，4 例 4 次尝试交换为 SBE 成功。4 例 SBE 失败中，6 例（4 例转为 AC，2 例转为 PC），仅 1 例 SBE 成功。没有直接与内镜类型相关的不良事件。
回顾性研究，单中心，选择内镜的方法缺乏标准化，存在未控制的变量（全身麻醉，学习曲线）。
在 Roux-en-Y 解剖结构的肝移植患者中，与 PC 相比，使用 SBE 进行胆管插管、治疗成功率和程序成功率更高，与整体队列相比，使用 SBE 时成功率更高。在过去的 4 年中，使用 SBE 的治疗成功率和 SBE 的成功率有所提高。如果改用 SBE，可以完成 AC 或 PC 失败的病例。
