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CC BY-NC-ND 4.0 · Endosc Int Open 2020; 08(06): E805-E808
DOI: 10.1055/a-1149-1619
Case report

Usefulness of endoscopic nasobiliary drainage-guided ERCP in patients with surgically altered anatomy (with video)

Yuichi Takano
Division of Gastroenterology, Department of Internal Medicine, Showa University Fujigaoka Hospital, Yokohama, Kanagawa, Japan
,
Tetsushi Azami
Division of Gastroenterology, Department of Internal Medicine, Showa University Fujigaoka Hospital, Yokohama, Kanagawa, Japan
,
Fumitaka Niiya
Division of Gastroenterology, Department of Internal Medicine, Showa University Fujigaoka Hospital, Yokohama, Kanagawa, Japan
,
Takahiro Kobayashi
Division of Gastroenterology, Department of Internal Medicine, Showa University Fujigaoka Hospital, Yokohama, Kanagawa, Japan
,
Naotaka Maruoka
Division of Gastroenterology, Department of Internal Medicine, Showa University Fujigaoka Hospital, Yokohama, Kanagawa, Japan
,
Masatsugu Nagahama
Division of Gastroenterology, Department of Internal Medicine, Showa University Fujigaoka Hospital, Yokohama, Kanagawa, Japan
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Abstract

Background and study aims Endoscopic retrograde cholangiopancreatography (ERCP) in patients with surgically altered anatomy is one of the most challenging endoscopic procedures. Although single- or double-balloon endoscopes have been widely used, reaching the papilla of Vater (hepaticojejunostomy/pancreaticojejunostomy site) is often difficult. For patients in whom treatment cannot be completed in a single session, we placed endoscopic nasobiliary drainage (ENBD) at the end of the procedure; in the second session, the scope was inserted following ENBD placement.

Patients and methods Three patients with surgically altered anatomy and who underwent ENBD-guided ERCP were retrospectively examined using the medical records.

Results There were two men and one woman, with an average age of 75 years. The surgical procedure were distal gastrectomy and Roux-en-Y reconstruction in all patients. The diagnosis were choledocholithiasis in two and bile duct stricture in one. Average time to reach the papilla was 50 minutes (range, 21–102) for the first ERCP and was shortened to 11 minutes (range, 5–17) for the second session under an indwelling ENBD. Treatment was successful in all patients without complications.

Conclusion ENBD-guided ERCP in patients with surgically altered anatomy was a useful method that facilitated scope insertion and shortened the procedure time.



Publication History

Received: 17 December 2019

Accepted: 02 March 2020

Article published online:
25 May 2020

© 2020. Owner and Copyright ©

© Georg Thieme Verlag KG
Stuttgart · New York

 

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