Bohuslav Kianička, 2 Clinic of Internal Medicine, Department of Gastroenterology, St. Anne's University Hospital Brno, 656 91 Brno, Czech Republic.
World J Gastroenterol. 2013 Nov 28;19(44):8047-55. doi: 10.3748/wjg.v19.i44.8047.
To evaluate single balloon enteroscopy in diagnostic and therapeutic endoscopic retrograde cholangiography (ERC) in patients with Roux-en-Y hepaticojejunoanastomosis (HJA).
The study took place from January 2009 to December 2011 and we retrospectively assessed 15 patients with Roux-en-Y HJA who had signs of biliary obstruction. In total, 23 ERC procedures were performed in these patients and a single balloon videoenteroscope (Olympus SIF Q 180) was used in all of the cases. A transparent overtube was drawn over the videoenteroscope and it freely moved on the working part of the enteroscope. Its distal end was equipped with a silicone balloon that was inflated by air from an external pump at a pressure of ≤ 5.4 kPa. The technical limitations or rather the parameters of the single balloon enteroscope (working length - 200 cm, diameter of the working channel - 2.8 mm, absence of Albarran bridge) showed the need for special endoscopic instrumentation.
Cannulation success was reached in diagnostic ERC in 12 of 15 patients. ERC findings were normal in 1 of 12 patients. ERC in the remaining 11 patients showed some pathological changes. One of these (cystic bile duct dilation) was subsequently resolved surgically. Endoscopic treatment was initialized in the remaining 10 patients (5 with HJA stenosis, 2 with choledocholithiasis, and 3 with both). This treatment was successful in 9 of 10 patients. The endoscopic therapeutic procedures included: balloon dilatation of HJA stenosis - 11 times (7 patients); choledocholitiasis extraction - five times (5 patients); biliary plastic stent placement - six times (4 patients); and removal of biliary stents placed by us - six times (4 patients). The mean time of performing a single ERC was 72 min. The longest procedure took 110 min and the shortest took 34 min. This shows that it is necessary to allow for more time in individual procedures. Furthermore, these procedures require the presence of an anesthesiologist. We did not observe any complications in these 15 patients.
This method is more demanding than standard endoscopic retrograde cholangiopancreatography due to altered postsurgical anatomy. However, it is effective, safe, and widens the possibilities of resolving biliary pathology.
评估单气囊小肠镜在 Roux-en-Y 胆肠吻合（HJA）患者诊断和治疗性内镜逆行胰胆管造影术（ERC）中的作用。
本研究于 2009 年 1 月至 2011 年 12 月进行，我们回顾性评估了 15 例有胆道梗阻迹象的 Roux-en-Y HJA 患者。这些患者共进行了 23 次 ERC 检查，所有病例均使用单气囊视频小肠镜（Olympus SIF Q 180）。视频小肠镜上套有透明外套管，可在外套管上自由移动，其远端装有一个硅胶气囊，由外部泵充气，压力≤5.4kPa。单气囊小肠镜的技术局限性（工作长度 200cm，工作通道直径 2.8mm，无 Albarran 桥）需要特殊的内镜仪器。
在 15 例患者的诊断性 ERC 中，12 例成功插管。12 例患者中有 1 例 ERC 结果正常。在其余 11 例患者中，ERC 显示出一些病理变化。其中 1 例（囊性胆管扩张）随后手术解决。在其余 10 例患者中（5 例 HJA 狭窄，2 例胆管结石，3 例两者均有）开始进行内镜治疗。这 10 例患者中有 9 例治疗成功。内镜治疗包括：HJA 狭窄球囊扩张 11 次（7 例）；胆管结石取出术 5 次（5 例）；胆道塑料支架置入术 6 次（4 例）；我们放置的胆道支架取出术 6 次（4 例）。每次 ERC 操作的平均时间为 72 分钟。最长的手术时间为 110 分钟，最短的为 34 分钟。这表明在个别手术中需要留出更多的时间。此外，这些手术需要麻醉师在场。我们在这 15 例患者中没有观察到任何并发症。
由于术后解剖结构改变，该方法比标准内镜逆行胰胆管造影术要求更高。然而，它是有效、安全的，并且扩大了解决胆道病变的可能性。
