Retrieval-balloon-assisted enterography for ERCP after Billroth Ⅱ gastroenterostomy and Braun anastomosis

• Published in: World journal of gastroenterology : WJG Vol. 20; no. 31; pp. 10921 - 10926
• Main Authors: Wu, Wen-Guang, Zhang, Wen-Jie, Gu, Jun, Zhao, Ming-Ning, Zhuang, Ming, Tao, Yi-Jing, Liu, Ying-Bin, Wang, Xue-Feng
• Format: Journal Article
• Language: English
• Published: United States Baishideng Publishing Group Inc 21.08.2014
• Subjects: Aged; Aged, 80 and over; Billroth; Catheters; Cholangiopancreatography, Endoscopic Retrograde - adverse effects; Cholangiopancreatography, Endoscopic Retrograde - instrumentation; Cholangitis - diagnosis; Cholangitis - etiology; Cholangitis - therapy; Duodenoscopes; enterography; Equipment Design; Female; Gallstones - diagnosis; Gallstones - etiology; Gallstones - therapy; Gastroenterostomy - adverse effects; Humans; Jaundice, Obstructive - diagnosis; Jaundice, Obstructive - etiology; Jaundice, Obstructive - therapy; Male; Middle Aged; Retrieval-balloon-assisted; Retrospective Studies; Retrospective Study; Stomach Neoplasms - surgery; Treatment Outcome; Retrieval-balloon-assisted enterography; Endoscopic retrograde cholangiopancreatography; Enterography success rate; Therapeutic success rate; Braun anastomosis; Billroth II gastroenterostomy; Gastrojejunal anastomosis; Efferent loop; Duodenoscope; Optimal enterography route
• ISSN: 1007-9327; 2219-2840
• DOI: 10.3748/wjg.v20.i31.10921

AIM: To describe an optimal route to the Braun anastomosis including the use of retrieval-balloon-assisted enterography.METHODS: Patients who received a Billroth Ⅱ gastroenterostomy(n = 109) and a Billroth Ⅱ gastroenterostomy with Braun anastomosis(n = 20) between January 2009 and May 2013 were analyzed in this study. Endoscopic ret-rograde cholangiopancreatography(ERCP) was performed under fluoroscopic control using a total length of 120 cm oblique-viewing duodenoscope with a 3.7-mm diameter working channel. For this procedure, we used a triplelumen retrieval balloon catheter in which a 0.035-inch guidewire could be inserted into the "open-channel" guidewire lumen while the balloon could be simultaneously injected and inflated through the other 2 lumens.RESULTS: For the patients with Billroth Ⅱ gastroenterostomy and Braun anastomosis, successful access to the papilla was gained in 17 patients(85%) and there was therapeutic success in 16 patients(80%). One patient had afferent loop perforation, but postoperative bleeding did not occur. For Billroth Ⅱ gastroenterostomy, there was failure in accessing the papilla in 15 patients(13.8%). ERCP was unsuccessful because of tumor infiltration(6 patients), a long afferent loop(9 patients), and cannulation failure(4 patients). The papilla was successfully accessed in 94 patients(86.2%), and there was therapeutic success in 90 patients(82.6%). Afferent loop perforation did not occur in any of these patients. One patient had hemorrhage 2 h after ERCP, which was successfully managed with conservative treatment.CONCLUSION: Retrieval-balloon-assisted enterography along an optimal route may improve the ERCP success rate after Billroth Ⅱ gastroenterostomy and Braun anastomosis.