Baylor Can - ERCP in Roux-en-Y

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Case

study

Double-balloon

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

S. Emmett MD and Damien B. Mallat

MD

Current affiliations:

Department of Gastroenterology, Baylor

University Medical

Center, 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.

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.

Barb in Texas - Together in the Fight, Whatever it Takes!

Son Ken (33) UC 91 - PSC 99 - Tx 6/21 & 6/30/07 @ Baylor in Dallas