Endoscopy 2009; 41(10): 849-854
DOI: 10.1055/s-0029-1215108
Original article

© Georg Thieme Verlag KG Stuttgart · New York

Effective ”short” double-balloon enteroscope for diagnostic and therapeutic ERCP in patients with altered gastrointestinal anatomy: a large case series

M.  Shimatani1 , M.  Matsushita1 , M.  Takaoka1 , M.  Koyabu1 , T.  Ikeura1 , K.  Kato1 , T.  Fukui1 , K.  Uchida1 , K.  Okazaki1
  • 1Third Department of Internal Medicine, Kansai Medical University, Osaka, Japan
Further Information

Publication History

submitted 29 May 2009

accepted after revision 30 July 2009

Publication Date:
11 September 2009 (online)

Background and study aims: Although endoscopic retrograde cholangiopancreatography (ERCP) is technically challenging in patients with altered gastrointestinal anatomy, a double-balloon enteroscope (DBE) permits examinations of a much longer segment of the small bowel than does a standard endoscope, and may be used to perform ERCP in such patients. Since only limited accessories are available for a conventional DBE, we performed ERCP with a ”short” DBE, which has a 2.8-mm working channel and a 152-cm working length and for which conventional accessories are available, in patients with altered gastrointestinal anatomy, and evaluated this alternative technique.

Patients and methods: In 68 patients with a Roux-en-Y total gastrectomy (n = 36), Billroth II gastrectomy (n = 17), or pancreatoduodenectomy (n = 15), ERCP (103 procedures) was performed with a ”short” DBE.

Results: Deep insertion was successful in 100/103 procedures (97 %). Cholangiogram was successfully obtained in 98/100 procedures (98 %). Treatment was accomplished in all 98 procedures in which a cholangiogram was obtained (100 %). Therapeutic interventions including stone extraction (n = 47), nasobiliary drainage (n = 38), stent placement (n = 36), sphincterotomy (n = 31), choledochojejunostomy dilation (n = 29), tumor biopsy (n = 10), and naso–pancreatic duct drainage (n = 1) were performed successfully. Complications occurred in 5/103 procedures (5 %), all in patients with Roux-en-Y reconstruction.

Conclusions: Despite the relatively high rate of complications seen in patients with Roux-en-Y reconstruction, ERCP with a ”short” DBE is effective in patients who have undergone bowel reconstruction.


M. Shimatani, MD 

Third Department of Internal Medicine
Kansai Medical University

2-3-1 Shinmachi
Osaka 573-1191

Fax: +81-72-804-2061

Email: shimatam@hirakata.kmu.ac.jp