Izawa Naoya, Tsuchida Kohei, Tominaga Keiichi, Fukushi Koh, Sakuma Fumi, Kashima Ken, Kunogi Yasuhito, Kanazawa Mimari, Tanaka Takanao, Nagashima Kazunori, Minaguchi Takahito, Iwasaki Mari, Yamamiya Akira, Jinnai Hidehito, Yamabe Akane, Hoshi Koki, Sugaya Takeshi, Iijima Makoto, Goda Kenichi, Irisawa Atsushi
Department of Gastroenterology, Dokkyo Medical University, 880 Kitakobayashi, Mibu, Tochigi 321-0293, Japan.
J Clin Med. 2021 Mar 6;10(5):1100. doi: 10.3390/jcm10051100.
Success rates of balloon enteroscopy-assisted endoscopic retrograde cholangiopancreatography (BE-ERCP) for patients with a reconstructed intestinal tract after surgical procedures are unsatisfactory. We retrospectively investigated the factors associated with unsuccessful BE-ERCP. Ninety-one patients who had a reconstructed intestinal tract after gastrectomy or choledochojejunostomy were enrolled. Age, sex, operative method, malignancy, endoscope type, endoscopist's skill, emergency procedure, and time required to reach the papilla/anastomosis were examined. The primary endpoints were the factors associated with unsuccessful BE-ERCP selective cannulation, while the secondary endpoints were the rate of reaching the papilla/anastomosis, causes of failure to reach the papilla/anastomosis, cannulation success rate, procedure success rate, and rate of adverse events. Younger age (odds ratio, 0.832; 95% CI, 0.706-0.982; = 0.001) and Roux-en-Y partial gastrectomy (odds ratio, 54.9; 95% CI, 1.09-2763; = 0.045) were associated with unsuccessful BE- ERCP. The rate of reaching the papilla/anastomosis was 92.3%, the success rate of biliary duct cannulation was 90.5%, procedure success rate was 78.0%, and the rate of adverse events was 5.6%. In conclusion, Roux-en-Y partial gastrectomy and younger age were associated with unsuccessful BE-ERCP. If BE-ERCP is extremely difficult to perform in such patients after Roux-en-Y partial gastrectomy, alternative procedures should be considered early.
对于接受外科手术后肠道重建的患者，气囊小肠镜辅助内镜逆行胰胆管造影术（BE-ERCP）的成功率并不理想。我们回顾性研究了与BE-ERCP失败相关的因素。纳入了91例接受胃切除术或胆总管空肠吻合术后肠道重建的患者。检查了年龄、性别、手术方式、恶性肿瘤、内镜类型、内镜医师技术、急诊手术以及到达乳头/吻合口所需时间。主要终点是与BE-ERCP选择性插管失败相关的因素，次要终点是到达乳头/吻合口的比率、未能到达乳头/吻合口的原因、插管成功率、手术成功率以及不良事件发生率。年龄较小（优势比，0.832；95%可信区间，0.706-0.982；P = 0.001）和Roux-en-Y部分胃切除术（优势比，54.9；95%可信区间，1.09-2763；P = 0.045）与BE-ERCP失败相关。到达乳头/吻合口的比率为92.3%，胆管插管成功率为90.5%，手术成功率为78.0%，不良事件发生率为5.6%。总之，Roux-en-Y部分胃切除术和年龄较小与BE-ERCP失败相关。如果在Roux-en-Y部分胃切除术后的此类患者中进行BE-ERCP极其困难，应尽早考虑替代手术。
