Direct cholangioscopy combined with doubleballoon enteroscope-assisted endoscopic retrograde cholangiopancreatography

• Published in: 世界胃肠病学杂志：英文版 Vol. 18; no. 28; pp. 3765 - 3769
• Main Author: Tatsuya Koshitani Shogo Matsuda Koji Takai Takayuki Motoyoshi Makoto Nishikata Yasuhide Yamashita Toshihiko Kirishima Naomi Yoshinami Hiroyuki Shintani Toshikazu Yoshikawa
• Format: Journal Article
• Language: English
• Published: 2012
• Subjects: 二氧化碳气; 内镜; 电子胃镜; 肠吻合术; 胃肠道; 胆管; 胆道; 造影
• ISSN: 1007-9327; 2219-2840
• DOI: 10.3748/wjg.v18.i28.3765

Double-balloon enteroscope （DBE）-assisted endoscopic retrograde cholangiopancreatography （ERCP） is an effective endoscopic approach for pancreatobiliary disorders in patients with altered gastrointestinal anatomy. Endoscopic interventions via DBE in these postoperative settings remain difficult because of the lack of an elevator and the use of extra-long ERCP accessories. Here, we report the usefulness of direct cholangioscopy with an ultra-slim gastroscope during DBE-assisted ERCP. Three patients with choledocholithiasis in postoperative settings （two patients after Billroth Ⅱ gastrojejunostomy and one patient after Roux-en-Y gastrojejunostomy） were treated. DBE was used to gain access to the papilla under carbon dioxide insufflation, and endoscopic sphincterotomy was performed with a conventional sphincterotome. For direct cholangioscopy, the enteroscope was exchanged for an ultra-slim gastroscope through an incision in the overtube, which was inserted directly into the bile duct. Direct cholangioscopy was used to extract retained bile duct stones in two cases and to confirm the complete clearance of stones in one case. Bile duct stones were eliminated with a 5-Fr basket catheter under direct visual control. No adverse events were noted in any of the three cases. Direct cholangioscopy with an ultra-slim gastroscope facilitates subsequent treatment within the bile duct. This procedure represents another potential option during DBE-assisted ERCP.