Takano Yuichi, Azami Tetsushi, Niiya Fumitaka, Kobayashi Takahiro, Maruoka Naotaka, Nagahama Masatsugu
Division of Gastroenterology, Department of Internal Medicine, Showa University Fujigaoka Hospital, Yokohama, Kanagawa, Japan.
Endosc Int Open. 2020 Jun;8(6):E805-E808. doi: 10.1055/a-1149-1619. Epub 2020 May 25.
Endoscopic retrograde cholangiopancreatography (ERCP) in patients with surgically altered anatomy is one of the most challenging endoscopic procedures. Although single- or double-balloon endoscopes have been widely used, reaching the papilla of Vater (hepaticojejunostomy/pancreaticojejunostomy site) is often difficult. For patients in whom treatment cannot be completed in a single session, we placed endoscopic nasobiliary drainage (ENBD) at the end of the procedure; in the second session, the scope was inserted following ENBD placement. Three patients with surgically altered anatomy and who underwent ENBD-guided ERCP were retrospectively examined using the medical records. There were two men and one woman, with an average age of 75 years. The surgical procedure were distal gastrectomy and Roux-en-Y reconstruction in all patients. The diagnosis were choledocholithiasis in two and bile duct stricture in one. Average time to reach the papilla was 50 minutes (range, 21-102) for the first ERCP and was shortened to 11 minutes (range, 5-17) for the second session under an indwelling ENBD. Treatment was successful in all patients without complications. ENBD-guided ERCP in patients with surgically altered anatomy was a useful method that facilitated scope insertion and shortened the procedure time.
对于解剖结构已手术改变的患者，内镜逆行胰胆管造影术（ERCP）是最具挑战性的内镜操作之一。尽管单气囊或双气囊内镜已被广泛使用，但到达十二指肠乳头（肝空肠吻合术/胰空肠吻合术部位）往往很困难。对于无法在一次手术中完成治疗的患者，我们在手术结束时放置了内镜鼻胆管引流（ENBD）；在第二次手术中，在放置ENBD后插入内镜。我们使用病历对3例解剖结构已手术改变且接受ENBD引导下ERCP的患者进行了回顾性研究。患者2男1女，平均年龄75岁。所有患者均接受了远端胃切除术和Roux-en-Y重建术。诊断为胆总管结石2例，胆管狭窄1例。首次ERCP到达乳头的平均时间为50分钟（范围21 - 102分钟），在留置ENBD的情况下，第二次手术缩短至11分钟（范围5 - 17分钟）。所有患者治疗均成功，无并发症。对于解剖结构已手术改变的患者，ENBD引导下的ERCP是一种有助于插入内镜并缩短手术时间的有用方法。
