使用传统侧视十二指肠镜在后胃切除患者中成功进行内镜逆行胰胆管造影术。

Use of the Conventional Side-viewing Duodenoscope for Successful Endoscopic Retrograde Cholangiopancreatography in Postgastrectomy Patients.

作者信息

Wu Wen-Guang, Mei Jia-wei, Zhao Ming-Ning, Zhang Wen-Jie, Gu Jun, Tao Yi-Jing, Liu Ying-Bin, Wang Xue-Feng

机构信息

Departments of *General Surgery and Laboratory of General Surgery, Xinhua Hospital, Affiliated to Shanghai Jiao Tong University, School of Medicine and Institute of Biliary Tract Disease, Shanghai Jiao Tong University School of Medicine †Pediatric Digestive Nutrition, Xinhua Hospital, Affiliated to Shanghai Jiao Tong University, School of Medicine, Shanghai, China.

出版信息

J Clin Gastroenterol. 2016 Mar;50(3):244-51. doi: 10.1097/MCG.0000000000000442.

OBJECTIVES

The aim of this study was to evaluate the usefulness of the conventional side-viewing duodenoscope for successful endoscopic retrograde cholangiopancreatography (ERCP) in postgastrectomy patients.

METHODS

A total of 220 consecutive patients with bile duct stones or a distal common bile duct stricture who had previously undergone gastrectomy and were referred for ERCP were analyzed for the outcome of their ERCP. All ERCP procedures were performed using a conventional side-viewing duodenoscope. In patients who had undergone a Billroth II gastroenterostomy and total gastrectomy with Roux-en-Y reconstruction, we also used the procedure of retrieval balloon-assisted enterography.

RESULTS

The study group included 220 patients who had previously undergone gastrectomy (77 women and 143 men; mean age, 72.2 y; range, 11 to 93 y). The overall enterography success rate was 90.5% (199/220), and the diagnostic and ERCP success rates were both 88.6% (195/220). Endoscopy was unsuccessful in 21 patients who received Billroth II gastroenterostomy and Roux-en-Y reconstruction. After successful endoscopy, diagnostic and ERCP success was not achieved in 4 patients with Billroth II gastroenterostomy, with or without Braun anastomosis, due to cannulation failure. The procedure-related complication rate was 5.5% (12/220), including immediate bleeding (0.9%, 2/220), pancreatitis (4.1%, 9/220), and perforation (0.5%, 1/220). There were no procedure-related deaths.

CONCLUSIONS

The side-viewing duodenoscope is a useful instrument for performing successful ERCP in patients postgastrectomy. In addition, retrieval balloon-assisted enterography may improve the enterography success rate in postgastrectomy patients with Billroth II and Roux-en-Y reconstruction.

目的

本研究旨在评估传统侧视十二指肠镜在胃切除术后患者成功进行内镜逆行胰胆管造影（ERCP）中的实用性。

方法

对220例先前接受过胃切除术且因胆管结石或胆总管远端狭窄而被转诊进行ERCP的连续患者的ERCP结果进行分析。所有ERCP操作均使用传统侧视十二指肠镜。对于接受毕罗Ⅱ式胃肠吻合术和Roux-en-Y重建的全胃切除术患者，我们还采用了回收球囊辅助小肠造影术。

结果

研究组包括220例先前接受过胃切除术的患者（77例女性和143例男性；平均年龄72.2岁；范围11至93岁）。小肠造影总体成功率为90.5%（199/220），诊断和ERCP成功率均为88.6%（195/220）。21例接受毕罗Ⅱ式胃肠吻合术和Roux-en-Y重建的患者内镜检查未成功。在内镜检查成功后，4例接受毕罗Ⅱ式胃肠吻合术（无论有无 Braun吻合）的患者因插管失败未实现诊断和ERCP成功。与操作相关的并发症发生率为5.5%（12/220），包括即刻出血（0.9%，2/220）、胰腺炎（4.1%，9/220）和穿孔（0.5%，1/220）。没有与操作相关的死亡病例。