Biliary Cannulation in Patients with Roux-en-Y Gastrectomy: An Analysis of the Factors Associated with Successful Cannulation

• Published in: Internal Medicine Vol. 59; no. 14; pp. 1687 - 1693
• Main Authors: Tanisaka, Yuki, Ryozawa, Shomei, Mizuide, Masafumi, Fujita, Akashi, Ogawa, Tomoya, Harada, Maiko, Noguchi, Tatsuya, Suzuki, Masahiro, Araki, Ryuichiro
• Format: Journal Article
• Language: English
• Published: Japan The Japanese Society of Internal Medicine 15.07.2020; Japan Science and Technology Agency
• Subjects: Balloon treatment; Cannulation; endoscopic retrograde cholangiopancreatography; factors associated with cannulation success; Gastrectomy; Internal medicine; Multivariate analysis; Original; Pancreas; retroflex position; short-type single-balloon enteroscope; Success; surgically altered gastrointestinal anatomy; endoscopic retrograde cholangiopancreatography; retroflex position; surgically altered gastrointestinal anatomy; factors associated with cannulation success; short-type single-balloon enteroscope
• ISSN: 0918-2918; 1349-7235
• DOI: 10.2169/internalmedicine.4245-19

Objective We investigated the results of biliary cannulation using a short-type single-balloon enteroscope in patients with a native papilla who had previously undergone Roux-en-Y gastrectomy and analyzed the factors associated with successful cannulation. Methods The study subjects consisted of patients with a native papilla who had previously undergone Roux-en-Y gastrectomy and endoscopic retrograde cholangiopancreatography using a short-type single-balloon enteroscope at our institution between September 2011 and July 2019. We carried out a retrospective investigation of the outcomes, including assessing the success rate of biliary cannulation, and analyzed the factors associated with successful cannulation. Results In total, 78 patients underwent biliary cannulation of a native papilla. The success rate of biliary cannulation was 80.8% (88.5% when including success on repeated attempts). The success rate of the standard cannulation technique was 60.3%, with the use of advanced cannulation techniques to secure the pancreatic duct providing the same additional effect as a normal anatomy. Adverse events occurred in 9.0% of cases. A multivariate analysis of the Roux-en-Y gastrectomy patients found that cannulation was more likely to be successful in patients in whom the scope could be placed in the retroflex position (odds ratio: 7.88, 95% confidence interval: 2.19-37.77, p<0.001). Conclusion Selective biliary cannulation using a short-type single-balloon enteroscope in patients with a native papilla who had undergone Roux-en-Y gastrectomy was effective and safe. The retroflex position provided a good papilla field of view and improved the success rate of biliary cannulation.