Single-balloon enteroscopy-assisted endoscopic retrograde cholangiopancreaticography in patients with surgically altered anatomy: higher failure rate in malignant biliary obstruction – a prospective single center cohort analysis

Abstract

Introduction. The performance of endoscopic retrograde cholangiopancreaticography (ERCP) in patients with post-surgically altered anatomy is technically ambitious. Our study aimed at comparing a cohort of patients having successfully undergone single-balloon enteroscopy (SBE)-assisted ERCP to those in whom SBE-ERCP failed. Methods. This trial is a prospective single center cohort study. Participants included 30 patients (median age 69.5 years, range 20–86 years) with previous pancreaticobiliary surgery. First, a conventional ERCP approach was attempted in all patients. Additionally, those patients in whom prior conventional ERCP had failed underwent SBE-ERCP (n = 26). Patients' baseline characteristics were retrieved and patient cohorts with and without successful SBE-ERCPs were compared and analyzed. Statistical analysis was applied. Univariate analysis was performed to detect possible risk factors of SBE-ERCP failure. Results. The overall success rate of SBE-ERCP, including two patients with percutaneous transhepatic cholangiography- assisted rendezvous technique was 65.4% (17/26). Patients with malignant obstructive cholestasis had a significantly higher failure rate compared to those with benign strictures (84.2% vs. 14.2%, p < 0.001). Discussion. SBE-ERCP is a promising tool for diagnostic and therapeutic procedures in the pancreaticobiliary system of selected, previously operated patients with failure of conventional ERCP. However, higher failure rates in malignant biliary obstruction should be taken into account.

Key Words::

• endoscopic retrograde cholangiopancreaticography
• single balloon
• single balloon enteroscopy endoscopic retrograde cholangiopancreaticography
• surgically altered anatomy

Acknowledgments

Guarantors of the article: Frank Lenze, Tobias Meister and Hansjoerg Ullerich. Author contributions: Frank Lenze and Tobias Meister contributed equally to this study; Frank Lenze and Tobias Meister: performance of SBE-ERCP procedures, study design, analysis and interpretation of data, drafting of the manuscript, literature research and statistical analysis; Philipp Matern: acquisition and analysis of data; Hauke Heinzow: critical revision of the manuscript and technical support; Wolfram Domschke: study idea and critical revision of the manuscript; Hansjoerg Ullerich: study idea, senior author, performance of SBE-ERCP procedures, and critical revision of the manuscript.

Declaration of interest: All authors have read and approved the submitted version of the manuscript.