Feasibility of Cap-Assisted Endoscopic Retrograde Cholangiopancreatography in Patients with Altered Gastrointestinal Anatomy

• Published in: Gut and liver Vol. 9; no. 1; pp. 109 - 112
• Main Authors: Ho Seok Ki, Chang Hwan Park, Chung Hwan Jun, Seon Young Park, Hyun Soo Kim, Sung Kyu Choi, Jong Sun Rew
• Format: Journal Article
• Language: Korean
• Published: 대한소화기내시경학회 31.01.2015
• Subjects: Billroth II gastrectomy; Cap; Cholangiopancreatography; endoscopic retrograde
• ISSN: 1976-2283; 2005-1212

Background/Aims: Endoscopic retrograde cholangiopancreatography (ERCP) is technically challenging in patients with altered gastrointestinal (GI) anatomy. We evaluated the feasibility of cap-assisted ERCP in patients with altered GI anatomy. Methods: The outcome of ERCP procedures (n=136) was analyzed in 78 patients with Billroth II (B-II) gastrectomy (n=72), Roux-en-Y total gastrectomy (n=4), and hepaticoduodenostomy (n=2). The intubation rate for reaching the papilla of Vater (POV), deep biliary cannulation rate, therapeutic interventions and procedure-related complications were analyzed. All of the procedures were conducted using a cap-fitted forward-viewing endoscope. Results: The rate of access to the POV was 97.1% (132/136). In cases with successful access, selective biliary cannulation was achieved in 98.5% (130/132) of the patients. The successful biliary cannulation rates were 100% (125/125) for B-II gastrectomy, 50% (2/4) for Roux-en-Y gastrectomy and 100% (3/3) for hepaticoduodenostomy. After selective biliary cannulation, therapeutic interventions, including stone extraction (n=57), sphincterotomy (n=54), stent placement (n=37), nasobiliary drainage (n=20), endoscopic papillary balloon dilatation (n=7) and mechanical lithotripsy (n=15), were performed successfully. The procedure-related complication rate was 8.8% (12/136), including immediate bleeding (5.9%, 8/136), pancreatitis (2.2%, 3/136), and perforation (0.7%, 1/136). There were no procedure-related deaths. Conclusions: Cap-assisted ERCP is efficient and safe in patients with altered GI anatomy. (Gut Liver 2015;9:109-112)