Endoscopic Retrograde Cholangiopancreatography in Patients with Previous Pancreaticoduodenectomy: A Single-Center Experience

• Published in: Digestive diseases and sciences Vol. 61; no. 1; pp. 293 - 302
• Main Authors: Park, Byung Kyu, Jeon, Tae Joo, Jayaraman, Vijay, Hammerle, Christopher, Gupta, Kapil, Jamil, Laith H., Lo, Simon K.
• Format: Journal Article
• Language: English
• Published: New York Springer US 01.01.2016; Springer; Springer Nature B.V
• Subjects: Adult; Aged; Aged, 80 and over; Biliary Tract Diseases - diagnosis; Biliary Tract Diseases - surgery; Biochemistry; Cholangiopancreatography, Endoscopic Retrograde - adverse effects; Cholangiopancreatography, Endoscopic Retrograde - instrumentation; Endoscopes, Gastrointestinal; Endoscopic retrograde cholangiopancreatography; Equipment Design; Female; Gastroenterology; Hepatology; Humans; Male; Medicine; Medicine & Public Health; Middle Aged; Oncology; Operative Time; Original Article; Pancreatic Diseases - diagnosis; Pancreatic Diseases - surgery; Pancreaticoduodenectomy; Pneumoviridae; Postoperative Complications - etiology; Republic of Korea; Retrospective Studies; Surgery, Plastic; Time Factors; Transplant Surgery; Treatment Outcome; Republic of Korea; ERCP; Conventional endoscope; Pancreaticoduodenectomy; Balloon-assisted enteroscope
• ISSN: 0163-2116; 1573-2568
• DOI: 10.1007/s10620-015-3861-z

Background Performing ERCP in patients with previous pancreaticoduodenectomy (PD) is technically challenging. Balloon-assisted ERCP has recently been recognized as a useful tool in patients with surgically altered anatomies. However, there are few studies that focus on ERCP in post-PD patients. Aim This study aimed to evaluate the outcome of ERCP in patients in post-PD and the patterns for type of endoscopes used. Methods Patients with previous PD who had undergone ERCP were included in this retrospective study. Results One hundred and thirty ERCP procedures were performed on 47 post-PD patients. The overall success of ERCP was 82.3 % (107/130). Endoscope insertion to the pancreaticobiliary anastomoses was accomplished in 93.8 % (122/130), which resulted in successful completion of ERCP in 87.7 % (107/122) of the procedures: 89.5 % (94/105) in biliary indications and 76.5 % (13/17) in pancreas indications. Using the conventional endoscopes (CEs) led to ERCP success in 66.4 % (71/107) of attempts versus 78.3 % (36/46) with balloon-assisted enteroscopes (BAEs). Among 105 cases in which CEs were initially tried, ERCP was successful in 69 (65.7 %) cases with CEs alone. When CEs failed to reach the pancreaticobiliary anastomoses, the subsequent use of BAEs resulted in a successful ERCP in 16/19 (84.2 %) of attempts. Conclusions ERCP in post-PD patients can be performed with a high success rate. We recommend that CEs should be used initially for ERCP in patients with PD and that BAEs be reserved for situation in which CEs have failed to reach the pancreaticobiliary anastomoses.