Endoscopic retrograde cholangiopancreatography using a single-balloon enteroscope in patients with altered Roux-en-Y anatomy

Background and study aims: Endoscopic retrograde cholangiopancreatography (ERCP) is challenging to perform in patients with postsurgical gastrointestinal anatomy. We assessed the diagnostic and therapeutic success rates using single-balloon enteroscopy in patients with Roux-en-Y anastomosis. Patients and methods: Patients who underwent single-balloon ERCP between April 2008 and February 2010 were retrospectively identified using a computerized endoscopy database. Diagnostic success was defined as successful duct cannulation or securing the diagnosis, and therapeutic success was defined as the ability to successfully carry out endoscopic therapy. Complications of ERCP were defined according to standard criteria. Results: A total of 50 patients (34-male, mean age 57 years, range 1985 years) with Roux-en-Y anastomosis underwent ERCP using a single-balloon enteroscope on 56 occasions. Indications for ERCP were cholestasis, acute cholangitis, recurrent primary sclerosing cholangitis with strictures, and choledocholithiasis. Overall diagnostic success was achieved in 39/56 cases (70%). Therapeutic success was achieved in 21/23 cases (91%). In 16 cases therapeutic intervention was not required. Therapeutic interventions included balloon dilation of strictures (n=14), retrieval of retained biliopancreatic stents (n=5), biliary stone extraction (n=2), insertion of biliopancreatic stents (n=4), and biliary and pancreatic sphincterotomy (n=5). No major complications occurred. Importantly, in 22/56 procedures (39%) a prior attempt at ERCP failed using conventional colonoscopes; single-balloon ERCP was successful in 15/22 (68%) of these cases. Conclusions: Single-balloon ERCP is feasible in patients with complex postsurgical Roux-en-Y anastomosis, allows diagnostic evaluation and therapeutic intervention in patients with pancreaticobiliary disease, and is a useful salvage technique in the majority of patients in whom ERCP using colonoscopies has failed.