Department of Gastroenterology and Hepatology, Université catholique de Louvain, Cliniques Universitaires Saint-Luc, Avenue Hippocrates 10, 1200 Brussels, Belgium.
Department of Gastroenterology and Hepatology, Université catholique de Louvain, Cliniques Universitaires Saint-Luc, Avenue Hippocrates 10, 1200 Brussels, Belgium.
Hepatobiliary Pancreat Dis Int. 2024 Oct;23(5):509-514. doi: 10.1016/j.hbpd.2023.07.004. Epub 2023 Jul 17.
Endoscopic treatment of biliopancreatic pathology is challenging due to surgically altered anatomy after Whipple's pancreaticoduodenectomy. This study aimed to evaluate the feasibility and safety of single-balloon enteroscopy-assisted endoscopic retrograde cholangiopancreatography (SBE-ERCP) to treat biliopancreatic pathology in patients with Whipple's pancreaticoduodenectomy surgical variants.
We retrospectively analyzed 106 SBE-ERCP procedures in 46 patients with Whipple's variants. Technical and clinical success rates and adverse events were evaluated.
Biliary SBE-ERCP was performed in 34 patients and pancreatic SBE-ERCP in 17, including 5 with both indications. From a total of 106 SBE-ERCP procedures, 76 were biliary indication with technical success rate of 68/76 (90%) procedures and clinical success rate of 30/34 (88%) patients. Mild adverse event rate was 8/76 (11%), without serious adverse events. From a total of 106 SBE-ERCP procedures, 30 were pancreatic indication with technical success rate of 24/30 (80%) procedures (P = 0.194 vs. biliary SBE-ERCP) and clinical success rate of 11/17 (65%) patients (P = 0.016 vs. biliary SBE-ERCP). Mild adverse event rate was 6/30 (20%) (P = 0.194 vs. biliary SBE-ERCP), without serious adverse events. After SBE-ERCP failure, endoscopic ultrasound-guided drainage, percutaneous drainage and redo surgery were alternative therapeutic options.
Biliopancreatic pathology after Whipple's pancreaticoduodenectomy variants can be treated using SBE-ERCP without serious adverse events. Technical and clinical success rates are high for biliary indications, whereas clinical success rate of pancreatic indications is significantly lower. SBE-ERCP can be considered as first-line treatment option in this patient group with surgically altered anatomy.
由于 Whipple 胰十二指肠切除术改变了手术解剖结构，因此内镜治疗胆胰病理具有挑战性。本研究旨在评估单气囊小肠镜辅助内镜逆行胰胆管造影术（SBE-ERCP）治疗 Whipple 胰十二指肠切除术手术变异患者胆胰病理的可行性和安全性。
我们回顾性分析了 46 例 Whipple 变异患者的 106 例 SBE-ERCP 手术。评估了技术和临床成功率以及不良事件。
34 例患者行胆道 SBE-ERCP，17 例患者行胰腺 SBE-ERCP，其中 5 例同时存在两种适应证。总共 106 例 SBE-ERCP 中，76 例为胆道适应证，技术成功率为 68/76（90%）例，临床成功率为 30/34（88%）例。轻度不良事件发生率为 8/76（11%），无严重不良事件。总共 106 例 SBE-ERCP 中，30 例为胰腺适应证，技术成功率为 24/30（80%）例（P=0.194 与胆道 SBE-ERCP 相比），临床成功率为 17/17（65%）例（P=0.016 与胆道 SBE-ERCP 相比）。轻度不良事件发生率为 6/30（20%）（P=0.194 与胆道 SBE-ERCP 相比），无严重不良事件。SBE-ERCP 失败后，可选择内镜超声引导引流、经皮引流和再次手术作为替代治疗方法。
Whipple 胰十二指肠切除术手术后变异的胆胰病理可通过 SBE-ERCP 治疗，无严重不良事件。胆道适应证的技术和临床成功率较高，而胰腺适应证的临床成功率明显较低。SBE-ERCP 可作为解剖结构改变的这组患者的一线治疗选择。
