Japan Digestive Disease Week 2025
International Poster Session14 (JDDW)
October 31, 14:00–14:56, Room 15 (Kobe International Exhibition Hall No.1 Building Digital Poster Venue)
IP-69_E
Analysis of strategies for overcoming technical challenges in DB-ERCP for surgically altered anatomy
- 1
- Department of Gastroenterology and Hepatology, Kansai Medical University Medical Center
- 2
- Third Department of Internal Medicine, Kansai Medical University
Background: As long-term survival improves after abdominal surgery, late-onset biliary diseases are increasing. This study evaluates outcomes of double-balloon enteroscopy (DB)-assisted ERCP in patients with surgically altered anatomy (SAA) and strategies for difficult cases.
Method: From July 2024 to March 2025, 148 patients with SAA underwent DB-ERCP for biliary disease among 433 ERCP cases. Success rates were analyzed for endoscope insertion, biliary access, and biliary interventions, along with strategies for challenging cases.
Results:Surgical reconstructions included Child reconstruction in 69 cases, Roux-en-Y hepaticojejunostomy 46, Roux-en-Y after gastrectomy 23, and Billroth-II 6.
Endoscope insertion: Success rate was 99.3%. One failure due to perforation. Difficulties occurred in 26.3% and were managed by scope/overtube manipulation 27, manual abdominal compression 5, and large-balloon anchoring 1.
Biliary access: Success rate was 98.6%. Failures included malignant obstruction 1 and unidentified anastomosis 1. Difficulties in 12.2% were managed using pancreatic guidewire 3, balloon catheter angulation 8, rotatable papillotome 6, and cholangioscopy 1.
Biliary interventions: Success rate was 98.6%. Two failures occurred due to bile duct perforation. Difficulties in 12.2% were managed with cholangioscopy 8, and others 10.
Adverse events occurred in 10.8%, including jejunal laceration/perforation 6, periampullary perforation 2, bile duct perforation 2, pancreatitis 4, bleeding 2.
Conclusions: DB-ERCP achieved high success and safety rates in SAA with advanced techniques.
Method: From July 2024 to March 2025, 148 patients with SAA underwent DB-ERCP for biliary disease among 433 ERCP cases. Success rates were analyzed for endoscope insertion, biliary access, and biliary interventions, along with strategies for challenging cases.
Results:Surgical reconstructions included Child reconstruction in 69 cases, Roux-en-Y hepaticojejunostomy 46, Roux-en-Y after gastrectomy 23, and Billroth-II 6.
Endoscope insertion: Success rate was 99.3%. One failure due to perforation. Difficulties occurred in 26.3% and were managed by scope/overtube manipulation 27, manual abdominal compression 5, and large-balloon anchoring 1.
Biliary access: Success rate was 98.6%. Failures included malignant obstruction 1 and unidentified anastomosis 1. Difficulties in 12.2% were managed using pancreatic guidewire 3, balloon catheter angulation 8, rotatable papillotome 6, and cholangioscopy 1.
Biliary interventions: Success rate was 98.6%. Two failures occurred due to bile duct perforation. Difficulties in 12.2% were managed with cholangioscopy 8, and others 10.
Adverse events occurred in 10.8%, including jejunal laceration/perforation 6, periampullary perforation 2, bile duct perforation 2, pancreatitis 4, bleeding 2.
Conclusions: DB-ERCP achieved high success and safety rates in SAA with advanced techniques.
- Index Term 1: Double balloon enteroscopy-assisted ERCP
- Index Term 2: Surgically altered anatomy