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著者: M Shimatani, M Matsushita, M Takaoka, M Koyabu, T Ikeura, K Kato, T Fukui, K Uchida, K Okazaki
雑誌名: Endoscopy. 2009 Oct;41(10):849-54. doi: 10.1055/s-0029-1215108. Epub 2009 Sep 11.
Abstract/Text
BACKGROUND AND STUDY AIMS: Although endoscopic retrograde cholangiopancreatography (ERCP) is technically challenging in patients with altered gastrointestinal anatomy, a double-balloon enteroscope (DBE) permits examinations of a much longer segment of the small bowel than does a standard endoscope, and may be used to perform ERCP in such patients. Since only limited accessories are available for a conventional DBE, we performed ERCP with a "short" DBE, which has a 2.8-mm working channel and a 152-cm working length and for which conventional accessories are available, in patients with altered gastrointestinal anatomy, and evaluated this alternative technique.
PATIENTS AND METHODS: In 68 patients with a Roux-en-Y total gastrectomy (n = 36), Billroth II gastrectomy (n = 17), or pancreatoduodenectomy (n = 15), ERCP (103 procedures) was performed with a "short" DBE.
RESULTS: Deep insertion was successful in 100/103 procedures (97 %). Cholangiogram was successfully obtained in 98/100 procedures (98 %). Treatment was accomplished in all 98 procedures in which a cholangiogram was obtained (100 %). Therapeutic interventions including stone extraction (n = 47), nasobiliary drainage (n = 38), stent placement (n = 36), sphincterotomy (n = 31), choledochojejunostomy dilation (n = 29), tumor biopsy (n = 10), and naso-pancreatic duct drainage (n = 1) were performed successfully. Complications occurred in 5/103 procedures (5 %), all in patients with Roux-en-Y reconstruction.
CONCLUSIONS: Despite the relatively high rate of complications seen in patients with Roux-en-Y reconstruction, ERCP with a "short" DBE is effective in patients who have undergone bowel reconstruction.
Georg Thieme Verlag KG Stuttgart. New York.
PMID 19750447 Endoscopy. 2009 Oct;41(10):849-54. doi: 10.1055/s-0029-1215108. Epub 2009 Sep 11.
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