Biliary Cannulation in Patients with Roux-en-Y Gastrectomy: An Analysis of the Factors Associated with Successful Cannulation

Intern Med. 2020 Jul 15;59(14):1687-1693. doi: 10.2169/internalmedicine.4245-19. Epub 2020 Apr 16.

Abstract

Objective We investigated the results of biliary cannulation using a short-type single-balloon enteroscope in patients with a native papilla who had previously undergone Roux-en-Y gastrectomy and analyzed the factors associated with successful cannulation. Methods The study subjects consisted of patients with a native papilla who had previously undergone Roux-en-Y gastrectomy and endoscopic retrograde cholangiopancreatography using a short-type single-balloon enteroscope at our institution between September 2011 and July 2019. We carried out a retrospective investigation of the outcomes, including assessing the success rate of biliary cannulation, and analyzed the factors associated with successful cannulation. Results In total, 78 patients underwent biliary cannulation of a native papilla. The success rate of biliary cannulation was 80.8% (88.5% when including success on repeated attempts). The success rate of the standard cannulation technique was 60.3%, with the use of advanced cannulation techniques to secure the pancreatic duct providing the same additional effect as a normal anatomy. Adverse events occurred in 9.0% of cases. A multivariate analysis of the Roux-en-Y gastrectomy patients found that cannulation was more likely to be successful in patients in whom the scope could be placed in the retroflex position (odds ratio: 7.88, 95% confidence interval: 2.19-37.77, p<0.001). Conclusion Selective biliary cannulation using a short-type single-balloon enteroscope in patients with a native papilla who had undergone Roux-en-Y gastrectomy was effective and safe. The retroflex position provided a good papilla field of view and improved the success rate of biliary cannulation.

Keywords: endoscopic retrograde cholangiopancreatography; factors associated with cannulation success; retroflex position; short-type single-balloon enteroscope; surgically altered gastrointestinal anatomy.

MeSH terms

  • Adult
  • Aged
  • Aged, 80 and over
  • Anastomosis, Roux-en-Y / adverse effects*
  • Balloon Enteroscopy / standards*
  • Biliary Tract*
  • Catheterization / standards*
  • Cholangiopancreatography, Endoscopic Retrograde / adverse effects*
  • Female
  • Gastrectomy / standards*
  • Humans
  • Male
  • Middle Aged
  • Pancreatic Ducts / surgery*
  • Practice Guidelines as Topic
  • Retrospective Studies