Background

Endoscopic access to the targeted site is a major challenge for the endoscopic retrograde cholangiopancreatography (ERCP) in patients undergoing Roux-en-Y (R-Y) reconstruction after total or subtotal gastrectomy. We aimed to evaluate the feasibility, reproducibility, and safety of mechanistic loop resolution strategies using a short-type single-balloon enteroscopy (short SBE) system.

Methods

Between February 2020 and March 2022, consecutive patients with a previous R-Y gastrectomy requiring ERCP were prospectively enrolled. Different mechanistic loop resolution strategies for two-dimensional loops, three-dimensionally rotated loops, and loops making a cane or S-shape were applied during the SBE approach.

Results

Forty-three short SBE-ERCP procedures were performed on 37 patients, with an approach success rate of 100.0% (43/43). The mean time to reach the jejunojejunal anastomosis and target site were 8.0 (6.0–11.0) minutes and 26.0 (16.0–36.0) minutes, respectively. The major challenges for the approach were the cane or S-shaped loop in the jejunojejunal anastomosis or Treitz ligament. The retroflex positioning of a SBE in front of the papilla was achieved in 86.0% (37/43), and the cannulation success rate in patients with an intact papilla was 90.9% (30/33). The initial, overall therapeutic successes, median total procedure time, and adverse event rate were 87.8%, 92.7%, 77.0 (IQR 56–100.5) minutes, and 11.6%, respectively.

Conclusions

Short SBE-ERCP using standardized mechanistic loop resolution strategies is effective and reproducible in patients with R-Y reconstruction after gastrectomy.

Trial registration

ClinicalTrial.gov (NCT04847167).

中文翻译：

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胃切除术后Roux-en-Y重建患者短型单球囊肠镜辅助内镜逆行胰胆管造影的机械循环解决策略（附视频）

背景

对于全胃或次全胃切除术后进行 Roux-en-Y (RY) 重建的患者，内镜进入目标部位是内镜逆行胰胆管造影 (ERCP) 的主要挑战。我们的目的是评估使用短型单气囊肠镜（短 SBE）系统的机械循环解决策略的可行性、可重复性和安全性。

方法

2020 年 2 月至 2022 年 3 月期间，连续纳入既往接受过 RY 胃切除术且需要 ERCP 的患者。在 SBE 方法中，针对二维环路、三维旋转环路以及形成手杖或 S 形的环路，应用了不同的机械环路分辨率策略。

结果

对 37 名患者进行了 43 次短程 SBE-ERCP 手术，入路成功率为 100.0% (43/43)。到达空肠空肠吻合口和目标部位的平均时间分别为 8.0 (6.0–11.0) 分钟和 26.0 (16.0–36.0) 分钟。该方法的主要挑战是空肠空肠吻合术或 Treitz 韧带中的甘蔗或 S 形环。SBE 在乳头前的卷舌定位成功率为 86.0% (37/43)，乳头完整的患者插管成功率为 90.9% (30/33)。初始总体治疗成功率、中位总手术时间和不良事件发生率分别为 87.8%、92.7%、77.0 (IQR 56–100.5) 分钟和 11.6%。

结论

使用标准化机械循环解决策略的短 SBE-ERCP 对于胃切除术后 RY 重建的患者是有效且可重复的。

试用注册

ClinicalTrial.gov (NCT04847167)。