Email Alert | RSS

Journal of Peking University (Health Sciences) ›› 2022, Vol. 54 ›› Issue (6): 1178-1184. doi: 10.19723/j.issn.1671-167X.2022.06.020

Previous Articles     Next Articles

Endoscopic retrograde cholangiopancreatography in patients after bilioenteric anstomosis

Wei ZHENG,Yong-hui HUANG*(),Hong CHANG,Wei YAO,Ke LI,Xiu-e YAN,Yao-peng ZHANG,Ying-chun WANG,Wen-zheng LIU   

  1. Department of Gastroenterology, Peking University Third Hospital, Beijing 100191, China
  • Received:2022-04-13 Online:2022-12-18 Published:2022-12-19
  • Contact: Yong-hui HUANG E-mail:13911765322@163.com
  • Supported by:
    the National Natural Science Foundation of China(82070653);the Capital Foundation for Clinical Characteristics and Application Research(z171100001017091)

RICH HTML

   

PDF (PC)

Abstract:

Objective: To distinguish clinical features, safety and efficiency of endoscopic retrograde cholangiopancreatography (ERCP) in patients after bilioenteric anstomosis based on retrospectively analyzed clinical data and endoscopy procedures. Methods: Data extracted from patients after bilioenteric anstomosis due to biliary disease treated with ERCP from January 2005 to December 2021 in the Department of Gastroenterology, Peking University Third Hospital were retrospectively analyzed. Clinical data and endoscopic pictures were reevaluated and analyzed. The patients were divided into three groups, including the patients with choledochoduodenostomy (CDD), Roux-en-Y hepaticojejunostomy (RYHJ) and Whipple. Differences between ERCP success and failure were conducted. Results: In the study, 89 cases with 132 ERCP procedures were involved, 9-80 years old, median 57 years old, containing 4 CDD, 30 RYHJ, 54 Whipple and 1 bile duct ileocecal anastomosis patients; The time between ERCP and surgery were 30 (1-40), 2.75 (0.5-14), 2 (0.3-19), and 10 years, respectively; The time between surgery and symptom were 240 (3-360), 12 (1-156), 22 (0-216), and 60 months, respectively. Fifty percent of CDD could succeed only under local anaesthesia, RYHJ (96.7%) and Whipple (100.0%) needed under general anaesthesia (P < 0.001). Successful first entry rates of CDD, RYHJ and Whipple were 100.0%, 40.0% and 77.8%, respectively. After changing the endoscopy type, successful entry rate could increase to 43.3% of RYHJ and 83.3% of Whipple. The successful entry rate of different anastomotic methods was significant (P < 0.001). The cannulation success rates of CDD, RYHJ and Whipple were 100.0%, 53.8% and 86.7% respectively, with significant difference between the groups (P=0.031). ERCP success rates of CDD, RYHJ and Whipple were 100.0%, 33.3% and 78.8% respectively, with significant difference between the groups (P < 0.001). Complications were found in 23.9% (21/88) patients, including infection (14.8%), pancreatitis (9.2%), bleeding (3.4%), and perforation (2.3%) ranked by incidence. Causes of ERCP in post bilioenteric anstomosis were anastomotic stenosis (50.0%, benign 39.3%, malignant 10.7%), choledocholithiasis (37.5%) and reflux cholangitis (12.5%). Anastomotic method was the only predicting factor of ERCP success in patients after bilioenteric anstomosis (OR=7, 95%CI: 2.591-18.912, P < 0.001). Conclusion: ERCP in post bilioenteric anstomosis patients with gastrointestinal reconstruction need general anaesthe-sia, with good safety and efficiency. The successful rate of RYHJ was significantly lower than Whipple. Anastomotic method was the only predicting factor of ERCP success.

Key words: Endoscopic retrograde cholangiopancreatography, Bilioenteric anastomosis, Roux-en-Y anastomosis, Gastrointestinal endoscopy

CLC Number: 

  • R657.4

Table 1

Characteristics of the patients with different anastomotic method"

Anastomotic method Time between ERCP and surgery/years, M (range) Time between surgery and symptom/months, M (range) Male, n (%)
CDD (n=4) 30 (1-40) 240 (3-360) 1 (25.0)
RYHJ (n=30) 2.75 (0.5-14) 12 (1-156) 14 (46.7)
Whipple (n=54) 2 (0.3-19) 22 (0-216) 30 (55.6)
Bile duct ileocecal anastomosis (n=1) 10 60 0 (0)
Total (n=89) 2.75 (0.3-40) 21 (0-360) 45 (50.6)
P value 0.104 0.205 0.577

Table 2

Clinical features of different anastomotic methods"

Variable Total (n=88) CDD (n=4) RYHJ (n=30) Whipple (n=54) P value
Age/years 55.9±12.9 53.8±15.7 52.4±13.0 58.1±12.4 0.137
Cause of surgery
   Benign 27 (30.7) 3 (75.0) 23 (76.7) 1 (1.9) < 0.001
   Malignant 61 (69.3) 1 (25.0) 7 (23.3) 53 (98.1)
History
   Duration/months 5.5 (0.1-132.0) 38.5 (0.1-120.0) 6.0 (0.1-132.0) 4.0 (0.3-50.0) 0.237
   Cholangitis 69 (78.4) 3 (75.0) 25 (83.3) 41 (75.9) 0.728
   Alcohol 25 (28.4) 0 (0) 10 (33.3) 15 (27.8) 0.385
   Hypertension 15 (17.0) 0 (0) 5 (16.7) 10 (18.5) 0.644
   Diabetes 24 (27.3) 0 (0) 7 (23.3) 17 (31.5) 0.338
   Hospitalization/d 9.0 (3.0-60.0) 8.5 (5.0-11.0) 10.0 (5.0-28.0) 8.0 (3.0-60.0) 0.514
ERCP procedure
   Anesthesia 85 (96.6) 2 (50.0) 29 (96.7) 54 (100.0) < 0.001
   Successful 1st entry 58 (65.9) 4 (100.0) 12 (40.0) 42 (77.8) < 0.001
   Successful 2nd entry 11 (12.5) - 6 (20.0) 5 (9.3) 0.363
   Successful entry 62 (70.5) 4 (100.0) 13 (43.3) 45 (83.3) < 0.001
Endoscopy used in cannulation 0.359
   GE 3 (4.8) 0 (0) 0 (0) 3 (6.7)
   DE 4 (6.5) 3 (75.0) 1 (7.7) 0 (0)
   CE 49 (79.0) 0 (0) 8 (61.5) 41 (91.1)
   SBE/DBE 4 (6.5) 0 (0) 4 (30.8) 0 (0)
   DCE/PTC 2 (3.2) 1 (25.0) 0 (0) 1 (2.2)
Cannulating technique 0.031
   Standard 50 (80.6) 4 (100.0) 7 (53.8) 39 (86.7)
   Change endoscope 11 (17.7) 0 (0) 6 (46.2) 5 (11.1)
   PTC assistant 1 (1.6) 0 (0) 0 (0) 1 (2.2)
   Successful cannulate 57 (91.9) 4 (100.0) 11 (84.6) 42 (93.3) 0.508
   Successful ERCP 56 (63.6) 4 (100.0) 10 (33.3) 42 (77.8) < 0.001
Complications
   AP 8 (9.2) 0 (0) 4 (13.3) 4 (7.4) < 0.001
   Infection 13 (14.8) 1 (25.0) 4 (13.3) 8 (14.8) 0.845
   Bleeding 3 (3.4) 0 (0) 0 (0) 3 (5.6) 0.396
   Perforation 2 (2.3) 0 (0) 0 (0) 2 (3.7) 0.544
CT consistency 58 (65.9) 2 (50.0) 22 (73.3) 34 (63.0) 0.004
MRCP consistency 63 (71.6) 3 (75.0) 22 (73.3) 38 (70.4) 0.062

Table 3

Indications of ERCP in patients post different bilioenteric anastomotic methods n (%)"

Indications Total (n=56) CDD (n=4) RYHJ (n=10) Whipple (n=42)
Choledocholithiasis 21 (37.5) 1 (25.0) 3 (30.0) 17 (40.5)
Anastomotic stenosis 28 (50.0) 1 (25.0) 7 (50.0) 22 (52.4)
   Benign 22 (39.3) 1 (25.0) 4 (40.0) 17 (40.5)
   Malignant 6 (10.7) 0 (0) 1 (10.0) 5 (11.9)
Reflux cholangitis 7 (12.5) 2 (50.0) 2 (20.0) 3 (7.1)

Table 4

Clinical features of ERCP succeed and failure patients"

Variable Succeed Failure t/Z value P value
Age/years 56.8±13.3 54.4±13.2 0.856 0.394
Male 31 (55.4) 14 (43.8) 0.295
Cause of surgery 0.013
   Benign 12 (21.4) 15 (46.9)
   Malignant 44 (78.6) 17 (53.1)
History
   Duration/month 2 (0-120) 6 (0.5-132) 1.797 0.072
   Time between ERCP and surgery/years 4.0 (0.5-40.0) 3.0 (0.3-19.0) 0.135 0.892
   Time between surgery and symptom/month 12 (0-360) 20.5 (1-216) 0.864 0.387
   Cholangitis 46 (82.1) 23 (71.9) 0.260
   Alcohol 14 (25.0) 11 (34.4) 0.348
   Hypertension 8 (14.3) 7 (21.9) 0.362
   Diabetes 16 (28.6) 8 (25.0) 0.717
   Hospitalization/d 8 (3-44) 10 (3-60) 1.578 0.114
   Anesthesia 54 (96.4) 31 (96.9) 0.911
1 Dimou FM , Adhikari D , Mehta HB , et al. Incidence of hepaticojejunostomy stricture after hepaticojejunostomy[J]. Surgery, 2016, 160 (3): 691- 698.
doi: 10.1016/j.surg.2016.05.021
2 Takano S , Fukasawa M , Shindo H , et al. Risk factors for perforation during endoscopic retrograde cholangiopancreatography in post-reconstruction intestinal tract[J]. World J Clin Cases, 2019, 7 (1): 10- 18.
doi: 10.12998/wjcc.v7.i1.10
3 Kawaguchi Y , Yamauchi H , Kida M , et al. Failure factors to reach the blind end using a short-type single-balloon enteroscope for ERCP with Roux-en-Y reconstruction: A multicenter retrospective study[J]. Gastroenterol Res Pract, 2019, 2019, 3536487.
4 Barakat MT , Adler DG . EUS-directed transgastric ERCP: A first-line option for ERCP following Roux-en-Y gastric bypass[J]. Endosc Ultrasound, 2021, 10 (3): 151- 153.
doi: 10.4103/eus.eus_148_20
5 Itokawa F , Itoi T , Ishii K , et al. Single- and double-balloon enteroscopy-assisted endoscopic retrograde cholangiopancreatography in patients with Roux-en-Y plus hepaticojejunostomy anastomosis and Whipple resection[J]. Dig Endosc, 2014, 26 (Suppl 2): 136- 143.
6 Gómez V , Petersen BT . Endoscopic retrograde cholangiopan-creatography in surgically altered anatomy[J]. Gastrointest Endosc Clin N Am, 2015, 25 (4): 631- 656.
doi: 10.1016/j.giec.2015.06.001
7 Escudero-Fabre A , Escallon A , Jr. Sack J , et al. Choledochoduodenostomy. Analysis of 71 cases followed for 5 to 15 years[J]. Ann Surg, 1991, 213 (6): 635- 644.
doi: 10.1097/00000658-199106000-00014
8 Uwuratuw JA , Bakhtiar B , Labeda I , et al. Recurrent cholangitis after choledochoduodenostomy: A case report[J]. Int J Surg Case Rep, 2022, 92, 106912.
doi: 10.1016/j.ijscr.2022.106912
9 Nennstiel S , Freivogel K , Faber A , et al. Endoscopic and percutaneous biliary interventions in patients with altered upper gastrointestinal anatomy: The Munich Multicenter Experience[J]. Surg Endosc, 2021, 35 (12): 6853- 6864.
doi: 10.1007/s00464-020-08191-2
10 Tanisaka Y , Ryozawa S , Mizuide M , et al. Status of single-balloon enteroscopy-assisted endoscopic retrograde cholangiopan-creatography in patients with surgically altered anatomy: Systematic review and meta-analysis on biliary interventions[J]. Dig Endosc, 2021, 33 (7): 1034- 1044.
doi: 10.1111/den.13878
11 Wang F , Xu B , Li Q , et al. Endoscopic retrograde cholangiopancreatography in patients with surgically altered anatomy: One single center's experience[J]. Medicine (Baltimore), 2016, 95 (52): e5743.
doi: 10.1097/MD.0000000000005743
12 Enestvedt BK , Kothari S , Pannala R , et al. Devices and techniques for ERCP in the surgically altered GI tract[J]. Gastro-intest Endosc, 2016, 83 (6): 1061- 1075.
doi: 10.1016/j.gie.2016.03.018
13 Cho E , Park CH , Kim Y , et al. Impact of scope exchange from a long single balloon enteroscope to a gastroscope during enteroscopy-assisted endoscopic retrograde cholangiopancreatography in patients with surgically altered anatomy[J]. Gut Liver, 2022, 16 (2): 308- 316.
doi: 10.5009/gnl210088
14 Hammad H , Brauer BC , Smolkin M , et al. Treating biliary-enteric anastomotic strictures with enteroscopy-ERCP requires fewer procedures than percutaneous transhepatic biliary drains[J]. Dig Dis Sci, 2019, 64 (9): 2638- 2644.
doi: 10.1007/s10620-019-05670-y
15 Weilert F , Binmoeller KF , Marson F , et al. Endoscopic ultrasound-guided anterograde treatment of biliary stones following gastric bypass[J]. Endoscopy, 2011, 43 (12): 1105- 1108.
doi: 10.1055/s-0030-1256961
[1] Ling-fu ZHANG,Chun-sheng HOU,Zhi XU,Li-xin WANG,Xiao-feng LING,Gang WANG,Long CUI,Dian-rong XIU. Clinical effect of laparoscopic transcystic drainage combined with common bile duct exploration for the patients with difficult biliary stones [J]. Journal of Peking University (Health Sciences), 2022, 54(6): 1185-1189.
[2] Ling-fu ZHANG,Chun-sheng HOU,Yong-hui HUANG,Zhi XU,Li-xin WANG,Xiao-feng LING,Gang WANG,Long CUI,Dian-rong XIU. Comparison of the minimally invasive treatments of laparoscopic and endosopic for common bile duct stones after gastrojejunostomy [J]. Journal of Peking University(Health Sciences), 2019, 51(2): 345-348.
Viewed
Full text


Abstract

Cited
  Shared   
  Discussed   
No Suggested Reading articles found!
Copyright © Journal of Peking University (Health Sciences), All Rights Reserved.
Powered by Beijing Magtech Co. Ltd