Efficacy of a modified double-guidewire technique using an uneven double lumen cannula (uneven method) in patients with surgically altered gastrointestinal anatomy (with video)

• DOI: 10.1007/s00464-019-07228-5
• Publication Date: 2019-10-31T03:03:30Z
• Authors: Mamoru Takenaka; Kosuke Minaga; Ken Kamata; Kentaro Yamao; Tomoe Yoshikawa; Rei Ishikawa; Ayana Okamoto; Tomohiro Yamazaki; Atsushi Nakai; Shunsuke Omoto; Yoriaki Komeda; Toshiharu Sakurai; Tomohiro Watanabe; Naoshi Nishida; Yasutaka Chiba; Chang-Il Kwon; Seok Jeong; Tae Hoon Lee; Masatoshi Kudo
• Keywords: Adult; Aged, 80 and over; Cholangiopancreatography, Endoscopic Retrograde; Male; Balloon Enteroscopy; Pancreatic Ducts; Equipment Design; Middle Aged; Catheterization; 3. Good health; Gastrointestinal Tract; 03 medical and health sciences; Postoperative Complications; Treatment Outcome; 0302 clinical medicine; Pancreatitis; Cannula; Humans; Female; Aged

Balloon enteroscopy-assisted endoscopic retrograde cholangiopancreatography (BE-ERCP) has been reported to be effective for patients with surgically altered gastrointestinal anatomy. However, selective biliary cannulation remains difficult in BE-ERCP. We examined the usefulness of a modified double-guidewire technique using an uneven double lumen cannula (the uneven method) for BE-ERCP in patients with surgically altered gastrointestinal anatomy.To clarify the usefulness of the uneven method for selective biliary cannulation in BE-ERCP in comparison to the pancreatic guidewire (PGW) method, 40 patients with surgically altered gastrointestinal anatomy who underwent BE-ERCP with successful placement of a guidewire in the pancreatic duct were evaluated. The uneven method was used in 18 cases (uneven group) and the PGW method was used in the remaining 22 cases (PGW group).The technical success rate of biliary cannulation was higher in the uneven group than in the PGW group (83.3 vs. 59.0%; P = 0.165). In addition, the time to biliary cannulation were significantly shorter in the uneven group than in the PGW group (6 vs. 18 min; P = 0.004; respectively). In the PGW group, post-ERCP pancreatitis (PEP) occurred in 3 of 22 cases (13.6%). No adverse events, including PEP, occurred in the uneven group.The uneven method may be a useful option of selective biliary cannulation in BE-ERCP for the patients with surgically altered gastrointestinal anatomy.