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Endoscopic Retrograde Cholangiopancreatography in Patients with Previous Pancreaticoduodenectomy: A Single-Center Experience

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Abstract

Background

Performing ERCP in patients with previous pancreaticoduodenectomy (PD) is technically challenging. Balloon-assisted ERCP has recently been recognized as a useful tool in patients with surgically altered anatomies. However, there are few studies that focus on ERCP in post-PD patients.

Aim

This study aimed to evaluate the outcome of ERCP in patients in post-PD and the patterns for type of endoscopes used.

Methods

Patients with previous PD who had undergone ERCP were included in this retrospective study.

Results

One hundred and thirty ERCP procedures were performed on 47 post-PD patients. The overall success of ERCP was 82.3 % (107/130). Endoscope insertion to the pancreaticobiliary anastomoses was accomplished in 93.8 % (122/130), which resulted in successful completion of ERCP in 87.7 % (107/122) of the procedures: 89.5 % (94/105) in biliary indications and 76.5 % (13/17) in pancreas indications. Using the conventional endoscopes (CEs) led to ERCP success in 66.4 % (71/107) of attempts versus 78.3 % (36/46) with balloon-assisted enteroscopes (BAEs). Among 105 cases in which CEs were initially tried, ERCP was successful in 69 (65.7 %) cases with CEs alone. When CEs failed to reach the pancreaticobiliary anastomoses, the subsequent use of BAEs resulted in a successful ERCP in 16/19 (84.2 %) of attempts.

Conclusions

ERCP in post-PD patients can be performed with a high success rate. We recommend that CEs should be used initially for ERCP in patients with PD and that BAEs be reserved for situation in which CEs have failed to reach the pancreaticobiliary anastomoses.

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Abbreviations

PD:

Pancreaticoduodenectomy

CE:

Conventional endoscope

BAE:

Balloon-assisted enteroscope

SBE:

Single-balloon enteroscope

DBE:

Double-balloon enteroscope

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Authors and Affiliations

  1. Division of Digestive Diseases, Cedars-Sinai Medical Center, Los Angeles, CA, USA

    Byung Kyu Park, Tae Joo Jeon, Kapil Gupta, Laith H. Jamil & Simon K. Lo

  2. Division of Gastroenterology, Department of Internal Medicine, National Health Insurance Service Ilsan Hospital, Goyang, Gyeonggi, Korea

    Byung Kyu Park

  3. Division of Gastroenterology, Department of Internal Medicine, Sanggye Paik Hospital, Inje University College of Medicine, Seoul, Korea

    Tae Joo Jeon

  4. Division of Gastroenterology, Department of Internal Medicine, University of Nevada School of Medicine, Las Vegas, NV, USA

    Vijay Jayaraman

  5. Idaho Gastroenterology Associates, Boise, ID, USA

    Christopher Hammerle

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  1. Byung Kyu Park
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Correspondence to Byung Kyu Park.

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Conflict of interest

Byung Kyu Park, Tae Joo Jeon, Vijay Jayaraman, Christopher Hammerle, Kapil Gupta, Laith H. Jamil, and Simon K. Lo have no conflict of interest or financial ties to disclose.

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Park, B.K., Jeon, T.J., Jayaraman, V. et al. Endoscopic Retrograde Cholangiopancreatography in Patients with Previous Pancreaticoduodenectomy: A Single-Center Experience. Dig Dis Sci 61, 293–302 (2016). https://doi.org/10.1007/s10620-015-3861-z

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  • DOI: https://doi.org/10.1007/s10620-015-3861-z

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