经皮放置导丝的创新技术可提高 ERCP 的成功率，优于 Roux-en-Y 胃旁路解剖中球囊进入镜辅助。
An innovative technique using a percutaneously placed guidewire allows for higher success rate for ERCP compared to balloon enteroscopy assistance in Roux-en-Y gastric bypass anatomy.
机构信息
Division of Gastroenterology and Hepatology, Mayo Clinic, 200 First Ave., S.W., Rochester, MN, 55905, USA.
Division of Interventional Radiology, Mayo Clinic, Rochester, MN, USA.
出版信息
Surg Endosc. 2020 Feb;34(2):806-813. doi: 10.1007/s00464-019-06832-9. Epub 2019 May 28.
BACKGROUND
Endoscopic retrograde cholangiopancreatography (ERCP) is technically challenging in Roux-en-Y gastric bypass (RYGB). Current approaches either have high failure rate, are resource intensive, or invasive.
OBJECTIVE
To describe successful adoption of an old technique for performance of ERCP in patients with RYGB anatomy employing enteroscopy with the assistance of a percutaneously placed guidewire, which facilitates both reaching and cannulating the major papilla.
METHOD
A retrospective cohort study in a tertiary-care center. We included patients with RYGB from 2015 to 2017 who underwent ERCP. We compared success rate and adverse events between rendezvous guidewire-assisted (RGA) and balloon-assisted enteroscopy (BAE) ERCP techniques.
RESULTS
Thirty patients with RYGB underwent 62 ERCPs. The mean age was 62.2 ± 11 years with female predominance 83.3%. The procedures were performed using BAE 43/62 (69.3%), RGA 13/62 (21%), gastrostomy tube 5/62 (8.1%), and colonoscope 1/62 (1.6%). In patients with a native papilla (n = 37 ERCPs), clinical success rate with BAE was 36.8% compared to 100% with RGA (P < 0.001). There was no significant difference in bleeding (P = 0.17), post-ERCP pancreatitis (P = 0.4), or luminal perforation (P = not estimated) between the two techniques in native papilla. The mean procedure time with the RGA was significantly shorter than successful BAE with mean difference: 33 min (95% CI 8-57 min, P = 0.01). Twenty-five ERCPs were performed in eight patients with non-native papilla. BAE success rate in non-native papilla was 95.8%. The mean procedure time of the BAE in non-native papilla was 111 ± 60 min. Native papillae were associated with a significantly higher BAE failure rate compared to non-native papillae (OR: 12; 95% CI 1.44-99.7, P = 0.02).
CONCLUSION
In patients with RYGB, RGA appears to be highly successful and safe in achieving clinical success for patients with native papilla as compared to BAE.
背景
内镜逆行胰胆管造影术（ERCP）在 Roux-en-Y 胃旁路术（RYGB）中具有技术挑战性。目前的方法要么失败率高，要么资源密集，要么具有侵入性。
目的
描述一种在 RYGB 解剖结构中使用带有经皮放置的导丝的推进式内镜进行 ERCP 的新技术，该技术可帮助到达并进行主乳头插管。
方法
在三级医疗中心进行回顾性队列研究。我们纳入了 2015 年至 2017 年间接受 ERCP 的 RYGB 患者。我们比较了经皮导丝辅助（RGA）和球囊辅助推进式内镜（BAE）ERCP 技术的成功率和不良事件。
结果
30 名 RYGB 患者进行了 62 次 ERCP。平均年龄为 62.2±11 岁，女性占 83.3%。这些手术分别使用 BAE（43/62，69.3%）、RGA（13/62，21%）、胃造口管（5/62，8.1%）和结肠镜（1/62，1.6%）进行。对于具有天然乳头的患者（n=37 例 ERCP），BAE 的临床成功率为 36.8%，而 RGA 为 100%（P<0.001）。两种技术在天然乳头处的出血（P=0.17）、ERCP 后胰腺炎（P=0.4）或管腔穿孔（P=未估计）之间无显著差异。RGA 的平均手术时间明显短于成功的 BAE，平均差异为 33 分钟（95%CI 8-57 分钟，P=0.01）。在 8 名非天然乳头患者中进行了 25 次 ERCP。非天然乳头的 BAE 成功率为 95.8%。非天然乳头的 BAE 平均手术时间为 111±60 分钟。与非天然乳头相比，天然乳头的 BAE 失败率显著更高（OR：12；95%CI 1.44-99.7，P=0.02）。
结论
在 RYGB 患者中，与 BAE 相比，RGA 似乎在实现具有天然乳头的患者的临床成功方面非常成功且安全。
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