经双气囊小肠镜行内镜下逆行胰胆管造影术在胃肠道解剖结构改变的患者中的应用。

Endoscopic retrograde cholangiopancreatography by double-balloon enteroscopy in patients with surgically altered gastrointestinal anatomy.

机构信息

Departamento de Endoscopia Gastrointestinal, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, México.

Department of Surgery, National Institute of Medical Sciences and Nutrition Salvador Zubirán, Mexico.

出版信息

Rev Esp Enferm Dig. 2020 Apr;112(4):278-283. doi: 10.17235/reed.2020.6940/2020.

DOI:10.17235/reed.2020.6940/2020

PMID:32188256

Abstract

BACKGROUND

Endoscopic retrograde cholangiopancreatography (ERCP) allows a diagnostic and therapeutic evaluation of pancreatobiliary diseases. However, the procedure in patients with surgically altered gastrointestinal anatomy represents a technical challenge.

OBJECTIVE

to report the diagnostic and therapeutic outcome of device-assisted enteroscopy (DAE) ERCP in patients with a surgically altered gastrointestinal anatomy.

METHODS

a prospective cohort of patients with a history of surgically altered gastrointestinal anatomy undergoing DAE-ERCP in a referral center was used. A double-balloon enteroscope was used to reach the papillary area or the bilio-enteric anastomosis. The clinical and endoscopic characteristics, and technical, diagnostic and therapeutic success were described. Clinical and endoscopic differences were evaluated according to diagnostic success, as well as the biochemical response in those patients with therapeutic success.

RESULTS

ninety-six procedures were included in the study in 75 patients. Roux-en-Y hepaticojejunostomy (RYHJ) was the main surgical anatomy (82.3%) and cholangitis was the main indication for ERCP (49%). Diagnostic success was obtained in 69.8% of the participants. Of these, therapeutic success was obtained in 83.6% (overall success 58.3%). Cases with a diagnostic success had a higher frequency of cholangiography compared to those without diagnostic success (94% vs 0%, p < 0.001), as well as a lower probability of a failed cannulation (1.5% vs 100%, p < 0.001). A significant improvement was observed in patients with a therapeutic success in bilirubin, transaminases and alkaline phosphatase levels (p < 0.05).

CONCLUSIONS

ERCP by means of double-balloon enteroscopy is a useful technique in patients with a surgically altered gastrointestinal anatomy, in whom access to the bile duct is required. However, these procedures are very challenging and diagnostic and therapeutic success where achieved in up to 60% of cases.

摘要

背景

内镜逆行胰胆管造影术（ERCP）可用于诊断和治疗胰胆疾病。然而，对于胃肠道解剖结构改变的患者，该操作具有一定的技术难度。

目的

报道经口内镜下胰胆管造影术（DAE-ERCP）在胃肠道解剖结构改变患者中的诊断和治疗效果。

方法

采用前瞻性队列研究方法，纳入在转诊中心接受 DAE-ERCP 的胃肠道解剖结构改变的患者。使用双气囊小肠镜到达乳头区域或胆肠吻合口。描述临床和内镜特征、技术、诊断和治疗成功率。根据诊断成功率以及治疗成功患者的生化反应，评估临床和内镜差异。

结果

本研究共纳入 75 例患者的 96 次操作。Roux-en-Y 胆肠吻合术（RYHJ）是主要的手术解剖结构（82.3%），胆管炎是 ERCP 的主要适应证（49%）。69.8%的患者获得了诊断成功。其中，83.6%（总体成功率 58.3%）的患者获得了治疗成功。与未获得诊断成功的患者相比，获得诊断成功的患者行胆管造影的频率更高（94% vs 0%，p<0.001），且胆管插管失败的概率更低（1.5% vs 100%，p<0.001）。治疗成功的患者胆红素、转氨酶和碱性磷酸酶水平显著改善（p<0.05）。