SpringerLink
Log in

Mechanistic loop resolution strategy for short-type single-balloon enteroscopy-assisted endoscopic retrograde cholangiopancreatography in patients with Roux-en-Y reconstruction after gastrectomy (with video)

  • Dynamic Manuscript
  • Published:
Surgical Endoscopy Aims and scope Submit manuscript

A Correction to this article was published on 28 August 2023

This article has been updated

Abstract

Background

Endoscopic access to the targeted site is a major challenge for the endoscopic retrograde cholangiopancreatography (ERCP) in patients undergoing Roux-en-Y (R-Y) reconstruction after total or subtotal gastrectomy. We aimed to evaluate the feasibility, reproducibility, and safety of mechanistic loop resolution strategies using a short-type single-balloon enteroscopy (short SBE) system.

Methods

Between February 2020 and March 2022, consecutive patients with a previous R-Y gastrectomy requiring ERCP were prospectively enrolled. Different mechanistic loop resolution strategies for two-dimensional loops, three-dimensionally rotated loops, and loops making a cane or S-shape were applied during the SBE approach.

Results

Forty-three short SBE-ERCP procedures were performed on 37 patients, with an approach success rate of 100.0% (43/43). The mean time to reach the jejunojejunal anastomosis and target site were 8.0 (6.0–11.0) minutes and 26.0 (16.0–36.0) minutes, respectively. The major challenges for the approach were the cane or S-shaped loop in the jejunojejunal anastomosis or Treitz ligament. The retroflex positioning of a SBE in front of the papilla was achieved in 86.0% (37/43), and the cannulation success rate in patients with an intact papilla was 90.9% (30/33). The initial, overall therapeutic successes, median total procedure time, and adverse event rate were 87.8%, 92.7%, 77.0 (IQR 56–100.5) minutes, and 11.6%, respectively.

Conclusions

Short SBE-ERCP using standardized mechanistic loop resolution strategies is effective and reproducible in patients with R-Y reconstruction after gastrectomy.

Trial registration

ClinicalTrial.gov (NCT04847167).

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Subscribe and save

Springer+ Basic
EUR 32.99 /Month
  • Get 10 units per month
  • Download Article/Chapter or Ebook
  • 1 Unit = 1 Article or 1 Chapter
  • Cancel anytime
Subscribe now

Buy Now

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3

Similar content being viewed by others

Change history

References

  1. Adler DG, Baron TH, Davila RE, Egan J, Hirota WK, Leighton JA, Qureshi W, Rajan E, Zuckerman MJ, Fanelli R, Wheeler-Harbaugh J, Faigel DO; Standards of Practice Committee of American Society for Gastrointestinal Endoscopy (2005) ASGE guideline: the role of ERCP in diseases of the biliary tract and the pancreas. Gastrointest Endosc 62:1–8

    Article  Google Scholar 

  2. Shimatani M, Takaoka M, Matsushita M, Okazaki K (2014) Endoscopic approaches for pancreatobiliary diseases in patients with altered gastrointestinal anatomy. Dig Endosc 26(Suppl 1):70–78

    Article  PubMed  Google Scholar 

  3. Tanisaka Y, Ryozawa S, Mizuide M, Kobayashi M, Fujita A, Minami K, Kobatake T, Omiya K, Iwano H, Araki R (2018) Usefulness of the “newly designed” short-type single-balloon enteroscope for ERCP in patients with Roux-en-Y gastrectomy: a pilot study. Endosc Int Open 6:E1417–E1422

    Article  PubMed  PubMed Central  Google Scholar 

  4. Shimatani M, Tokuhara M, Kato K, Miyamoto S, Masuda M, Sakao M, Fukata N, Miyoshi H, Ikeura T, Takaoka M, Okazaki K (2017) Utility of newly developed short-type double-balloon endoscopy for endoscopic retrograde cholangiography in postoperative patients. J Gastroenterol Hepatol 32:1348–1354

    Article  PubMed  Google Scholar 

  5. Krutsri C, Kida M, Yamauchi H, Iwai T, Imaizumi H, Koizumi W (2019) Current status of endoscopic retrograde cholangiopancreatography in patients with surgically altered anatomy. World J Gastroenterol 25:3313–3333

    Article  PubMed  PubMed Central  Google Scholar 

  6. Klair JS, Jayaraj M, Chandrasekar VT, Priyan H, Law J, Murali AR, Singh D, Larsen M, Irani S, Kozarek R, Ross A, Krishnamoorthi R (2020) ERCP with overtube-assisted enteroscopy in patients with Roux-en-Y gastric bypass anatomy: a systematic review and meta-analysis. Endoscopy 52:824–832

    Article  PubMed  Google Scholar 

  7. Ishii K, Itoi T, Tonozuka R, Itokawa F, Sofuni A, Tsuchiya T, Tsuji S, Ikeuchi N, Kamada K, Umeda J, Tanaka R, Honjo M, Mukai S, Fujita M, Moriyasu F, Baron TH, Gotoda T (2016) Balloon enteroscopy-assisted ERCP in patients with Roux-en-Y gastrectomy and intact papillae (with videos). Gastrointest Endosc 83:377-386.e6

    Article  PubMed  Google Scholar 

  8. Tanisaka Y, Ryozawa S, Mizuide M, Araki R, Fujita A, Ogawa T, Tashima T, Noguchi T, Suzuki M, Katsuda H (2021) Status of single-balloon enteroscopy-assisted endoscopic retrograde cholangiopancreatography in patients with surgically altered anatomy: systematic review and meta-analysis on biliary interventions. Dig Endosc 33:1034–1044

    Article  PubMed  Google Scholar 

  9. Technology Committee ASGE, Chauhan SS, Manfredi MA, Abu Dayyeh BK, Enestvedt BK, Fujii-Lau LL, Komanduri S, Konda V, Maple JT, Murad FM, Pannala R, Thosani NC, Banerjee S (2015) Enteroscopy. Gastrointest Endosc 82:975–990

    Article  Google Scholar 

  10. Cotton PB, Eisen GM, Aabakken L, Baron TH, Hutter MM, Jacobson BC, Mergener K, Nemcek A Jr, Petersen BT, Petrini JL, Pike IM, Rabeneck L, Romagnuolo J, Vargo JJ (2010) A lexicon for endoscopic adverse events: report of an ASGE workshop. Gastrointest Endosc 71:446–454

    Article  PubMed  Google Scholar 

  11. Kiriyama S, Kozaka K, Takada T, Strasberg SM, Pitt HA, Gabata T, Hata J, Liau KH, Miura F, Horiguchi A, Liu KH, Su CH, Wada K, Jagannath P, Itoi T, Gouma DJ, Mori Y, Mukai S, Giménez ME, Huang WS, Kim MH, Okamoto K, Belli G, Dervenis C, Chan ACW, Lau WY, Endo I, Gomi H, Yoshida M, Mayumi T, Baron TH, de Santibañes E, Teoh AYB, Hwang TL, Ker CG, Chen MF, Han HS, Yoon YS, Choi IS, Yoon DS, Higuchi R, Kitano S, Inomata M, Deziel DJ, Jonas E, Hirata K, Sumiyama Y, Inui K, Yamamoto M (2018) Tokyo Guidelines 2018: diagnostic criteria and severity grading of acute cholangitis (with videos). J Hepatobiliary Pancreat Sci 25:17–30

    Article  PubMed  Google Scholar 

  12. Yokoe M, Hata J, Takada T, Strasberg SM, Asbun HJ, Wakabayashi G, Kozaka K, Endo I, Deziel DJ, Miura F, Okamoto K, Hwang TL, Huang WS, Ker CG, Chen MF, Han HS, Yoon YS, Choi IS, Yoon DS, Noguchi Y, Shikata S, Ukai T, Higuchi R, Gabata T, Mori Y, Iwashita Y, Hibi T, Jagannath P, Jonas E, Liau KH, Dervenis C, Gouma DJ, Cherqui D, Belli G, Garden OJ, Giménez ME, de Santibañes E, Suzuki K, Umezawa A, Supe AN, Pitt HA, Singh H, Chan ACW, Lau WY, Teoh AYB, Honda G, Sugioka A, Asai K, Gomi H, Itoi T, Kiriyama S, Yoshida M, Mayumi T, Matsumura N, Tokumura H, Kitano S, Hirata K, Inui K, Sumiyama Y, Yamamoto M (2018) Tokyo Guidelines 2018: diagnostic criteria and severity grading of acute cholecystitis (with videos). J Hepatobiliary Pancreat Sci 25:41–54

    Article  PubMed  Google Scholar 

  13. Shimatani M, Takaoka M, Okazaki K (2014) Tips for double balloon enteroscopy in patients with Roux-en-Y reconstruction and modified child surgery. J Hepatobiliary Pancreat Sci 21:E22–E28

    Article  PubMed  Google Scholar 

  14. Tanisaka Y, Ryozawa S, Itoi T, Yamauchi H, Katanuma A, Okabe Y, Irisawa A, Nakahara K, Iwasaki E, Ishii K, Kin T, Terabe H, Izawa N, Morita R, Minami K, Araki R, Fujita A, Ogawa T, Mizuide M, Kida M (2022) Efficacy and factors affecting procedure results of short-type single-balloon enteroscopy-assisted ERCP for altered anatomy: a multicenter cohort in Japan. Gastrointest Endosc 95:310-318.e1

    Article  PubMed  Google Scholar 

Download references

Acknowledgements

This study was conducted as part of the BE-ERCP research projects of the New Medical Technology Study Group of the Korean Pancreatobiliary Association. We thank Woohyun Cho, MFA (Medical Information & Media Center, Ajou University School of Medicine), for medical illustrations for this article.

Funding

This work was supported by a National Research Foundation of Korea (NRF) grant funded by the Korean government (NRF-2021R1C1C1008619), a grant of the Korea Health Technology R&D Project through the Korea Health Industry Development Institute (KHIDI), funded by the Ministry of Health & Welfare, Republic of Korea (Grant Number: HR21C1003), and the Ministry of Science and ICT (MSIT), Korea, under the Information Technology Research Center (ITRC) support program (IITP-2022-2020-0-01461) supervised by the Institute for Information & Communications Technology Planning & Evaluation (IITP).

Author information

Authors and Affiliations

  1. Department of Gastroenterology, Ajou University School of Medicine, 164 Worldcup-ro, Yeongtong-gu, Suwon-si, Gyeonggi-do, 16499, Korea

    Min Jae Yang, ** Hong Kim, Jae Chul Hwang & Byung Moo Yoo

  2. Division of Gastroenterology, Department of Internal Medicine, Hallym University Dongtan Sacred Heart Hospital, Hallym University College of Medicine, Hwaseong, Korea

    Se Woo Park

  3. Digestive Disease Center, CHA Bundang Medical Center, CHA University School of Medicine, Seongnam, Korea

    Chang-Il Kwon

  4. Division of Gastroenterology, Department of Internal Medicine, Inha University School of Medicine, Incheon, Korea

    Seok Jeong

  5. New Medical Technology Study Group, Korean Pancreatobiliary Association, Seoul, Korea

    Min Jae Yang, Se Woo Park, Chang-Il Kwon & Seok Jeong

Authors
  1. Min Jae Yang
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. ** Hong Kim
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Jae Chul Hwang
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Byung Moo Yoo
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Se Woo Park
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Chang-Il Kwon
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Seok Jeong
    View author publications

    You can also search for this author in PubMed Google Scholar

Contributions

MJY and JHK conceived and designed the study. MJY, JCH, and BMY analyzed and interpreted the data. MJY drafted the article. MJY, JHK, SWP, CIK, and SJ critically revised the article for important intellectual content. All authors approved the final version.

Corresponding author

Correspondence to ** Hong Kim.

Ethics declarations

Disclosures

Min Jae Yang, ** Hong Kim, Jae Chul Hwang, Byung Moo Yoo, Se Woo Park, Chang-Il Kwon, and Seok Jeong have no conflicts of interest or financial ties to disclose.

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Supplementary Information

Below is the link to the electronic supplementary material.

Supplementary file1 (MP4 41573 kb) Mechanistic loop resolution strategy for gastrectomy with R-Y reconstruction

Rights and permissions

Springer Nature or its licensor (e.g. a society or other partner) holds exclusive rights to this article under a publishing agreement with the author(s) or other rightsholder(s); author self-archiving of the accepted manuscript version of this article is solely governed by the terms of such publishing agreement and applicable law.

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Yang, M.J., Kim, J.H., Hwang, J.C. et al. Mechanistic loop resolution strategy for short-type single-balloon enteroscopy-assisted endoscopic retrograde cholangiopancreatography in patients with Roux-en-Y reconstruction after gastrectomy (with video). Surg Endosc 36, 8690–8696 (2022). https://doi.org/10.1007/s00464-022-09575-2

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00464-022-09575-2

Keywords

Search

Navigation