Endoscopy 2017; 49(12): 1256-1261
DOI: 10.1055/s-0043-117406
Innovations and brief communications
© Georg Thieme Verlag KG Stuttgart · New York

Comparison of two fluoroscopic images to ensure efficient scope insertion for biliary intervention in patients with Roux-en-Y hepaticojejunostomy

Koichiro Tsutsumi1, Hironari Kato1, Ken Hirao2, Sho Mizukawa1, Shinichiro Muro1, Yutaka Akimoto1, Daisuke Uchida1, Kazuyuki Matsumoto1, Takeshi Tomoda1, Shigeru Horiguchi1, Shuntaro Yabe1, Hiroyuki Seki1, Yasuhiro Noma1, Naoki Yamamoto1, Ryo Harada1, Tsuneyoshi Ogawa2, Hiroyuki Okada1, 3
  • 1Department of Gastroenterology, Okayama University Hospital, Okayama, Japan
  • 2Department of Internal Medicine, Hiroshima City Hiroshima Citizens Hospital, Hiroshima, Japan
  • 3Department of Gastroenterology and Hepatology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, Japan
Further Information

Publication History

submitted 09 March 2017

accepted after revision 30 June 2017

Publication Date:
12 September 2017 (eFirst)


Background and study aims No standard procedure for endoscopic retrograde cholangiopancreatography is available for patients with Roux-en-Y hepaticojejunostomy (RYHJ) with side-to-end hepaticojejunostomy. We therefore explored methods of efficient scope insertion at a hepaticojejunostomy site.

Patients and methods Patients with suspected biliary disease were prospectively enrolled. Based on two fluoroscopic images obtained on scope insertion into each lumen of a two-pronged Roux-en-Y anastomosis, we selected the lumen in which the distal end of the scope progressed toward the patient’s liver or head. The accuracy of this method for selecting the correct lumen leading to the hepaticojejunostomy site was investigated.

Results Of the 33 included patients, successful insertion to the hepaticojejunostomy site was achieved in 32 (97 %), 26 (81 %) of whom had undergone the imaging method. The accuracy of the method was 88 % (23/26). The time required for insertion between the anastomotic site and the hepaticojejunostomy site was shorter when the lumen selection had been correct (13 minutes [7 – 30] (n = 23) vs. 18 minutes [8 – 28] (n = 9); P = 0.95).

Conclusion This method based on two fluoroscopic images was useful for achieving efficient scope insertion in patients with RYHJ.

Trial registered at University Hospital Medical Information Network Clinical Trials Registry (UMIN000014183).