Double-balloon ERCP in patients who have undergone Roux-en-Y surgery: a case series

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doi:10.1016/j.gie.2007.06.056 Copyright © 2007 American Society for Gastrointestinal Endoscopy Published by Mosby, Inc.

Case study

Double-balloon ERCP in patients who have undergone Roux-en-Y surgery: a case series

S. Emmett MD, a and Damien B. Mallat MDa aCurrent affiliations: Department of Gastroenterology, Baylor University Medical Center, Dallas, Texas, USA Received 30 April 2007; accepted 30 June 2007. Dallas, Texas, USA. Available online 24 October 2007.

Background

ERCP is technically challenging in patients who have had a long-limb Roux-en-Y surgical procedure. The recent introduction of the double-balloon endoscope permits the examination of a much longer segment of the small bowel compared with a standard endoscope and may be used to perform ERCP in these patients. Objective

To report successful use of double-balloon ERCP in patients who have had a Roux-en-Y surgical procedure. Patients

Fourteen patients with a history of either Roux-en-Y gastric bypass weight-reduction surgery or Roux-en-Y pancreatobiliary surgery required diagnostic and/or therapeutic pancreatobiliary intervention. Design

Case report. Intervention

Double-balloon ERCP. Results

Fourteen patients underwent a total of 20 ERCPs with the double-balloon endoscopy system. The ampulla was successfully reached in 85% of total cases (100% of patients who have had Roux-en-Y weight reduction surgery), with adequate cannulation of either the biliary or pancreatic duct in 80% (88% of patients for weight reduction). Therapeutic intervention, including stone removal, pancreatobiliary-duct dilation, sphincterotomy, stent placement, and removal of previously placed stents, was performed successfully in 6 cases. The mean age was 47 years old. The mean (± standard deviation) total duration of the procedure was 99 ± 48 minutes. There were no immediate or short-term complications. Conclusions

The double-balloon endoscopy system permits diagnostic and therapeutic ERCP in patients who have had long-limb surgical procedures. Our experience demonstrated that this procedure is well tolerated, safe, and has a high success rate.

Reprint requests: S. Emmett, MD, Department of Gastroenterology, Baylor University Medical Center, 3500 Gaston Ave, Dallas, TX 75246.

Gastrointestinal Endoscopy Volume 66, Issue 5, November 2007, Pages 1038-1041