Short Single-Balloon Enteroscope-Assisted ERCP for Patients with Surgically Altered Anatomy: A Retrospective Cohort Study

Aims: Performing ERCP in patients with surgically altered anatomy poses challenges. The short single-balloon enteroscope has revolutionized ERCP. This study aims to evaluate demographics, efficacy, safety, and adverse events associated with enteroscopic ERCP.

Methods: All patients with altered anatomy who underwent ERCP from March 2019 to October 2023 were included. Adverse events were recorded. All patients were followed up for a maximum of 3 months.

Results: A total of 63 patients aged 12 to 80 (58% males) underwent 100 procedures and were included in this analysis. The enteroscopy, diagnostic, therapeutic, and total procedural success rates were 95, 94.7, 97.7, and 88%, respectively ([Table 1]). Failure to reach the anastomotic site and failed biliary cannulation were the most common causes of procedure failure. The most common diagnosis was the presence of biliary calculi (intrahepatic, common bile duct, and hepaticojejunostomy site calculi) in 38.1%, followed by anastomotic site stricture in 19%. Seven patients with large biliary calculi required biliary lithotripsy followed by ERCP to achieve biliary clearance. Six patients with large anastomotic site calculi were fragmented using a polypectomy snare. Adverse events occurred in 6.8% of patients, with two serious adverse events. One required surgical intervention, and the other underwent endoscopic closure of afferent limb perforation.

Table 1 Outcomes of short single-balloon enteroscopy–assisted ERCP per type of surgery

	Enteroscopy success	Diagnostic success	Therapeutic success	Total procedural success
Billroth II gastrectomy	23/23 (100%)	22/23 (95.65%)	21/22 (95.45%)	21/23 (91.30%)
Hepaticojejunostomy with Roux-en-Y	37/39 (94.87%)	36/37 (97.29%)	36/36 (100%)	36/39 (92.30%)
Roux-en-Y gastrectomy	13/13 (100%)	10/13 (76.92%)	10/10 (100%)	10/13 (76.92%)
Whipple’s pancreatico-duodenectomy	21/23 (91.30%)	21/21 (100%)	20/21 (95.23%)	20/23 (86.95%)
Others (hepatectomy, pyloroduodenal jejunostomy)	1/2 (50%)	1/2 (50%)	1/2 (50%)	1/2 (50%)
	95/100 (95%)	90/95 (94.73%)	88/90 (97.77%)	88/100 (88%)

Conclusions: Short single-balloon enteroscope-assisted ERCP in patients with surgically altered anatomy is efficacious and safe. The novel technique of snare fragmentation can be used effectively in cases involving large calculi at the bilio-enteric anastomotic site.

Publication History

Article published online:
22 April 2024