Short type single-balloon enteroscope-assisted ERCP for patients with surgically altered anatomy Young Award

Aim: To evaluate the efficacy and factors affecting the procedureresults of short-type single-balloon enteroscope (short SBE)－assisted ERCP for patients with surgically altered anatomy (SAA).
Methods: The data of patients who underwent ERCP-related procedures using short SBE (SIF-H290S; Olympus Medical Systems) which has a working length of 152 cm and a 3.2 mm working channel from July 2013 to January 2022 were analyzed.
Results: Overall, 417 procedures in 241 patients with SAA (Gastrectomy with Roux－en－Y (117 patients, 154 procedures), Hepaticojejunostomy with Roux－en－Y (42 patients, 77 procedures), Pancreaticoduodenectomy (42 patients, 123 procedures, and Billroth-II gastrectomy (40 patients, 63 procedures)) were included in this analysis. The enteroscopy (reaching the target site), cannulation (cases which could reach the target site), and total procedural success rates were 95.9%, 95.0%, 90.2%, respectively. Adverse events occurred in 5.0% (Pancreatitis 2.4%, cholangitis 1.9%, perforation 0.7%) of procedures. Multiple logistic regression analysis indicated that first time ERCP, Roux－en－Y reconstruction, and malignancy were factors affecting the total procedural failure. As malignancy sometimes caused the invasion of the small intestine or papilla, EUS－guided biliary drainage was a good alternative procedure.
Conclusions: Short SBE－assisted ERCP in patients with surgically altered anatomy was effective. Furthermore, it clarified factors affecting procedure results. Proficiency with alternative treatment techniques is required in difficult cases.