Colonoscopy-assisted preplacement of guide tube for endoscopic retrograde cholangiopancreatography in patients with complex surgically altered anatomy.

BACKGROUND

Balloon-assisted enteroscopy is limited by a small working channel and few compatible accessories. Herein, we assessed a novel endoscopic retrograde cholangiopancreatography (ERCP) involving a long-type single-balloon enteroscope (200 cm length; 2.8 mm channel), requiring dual-operator manipulation. Although standard in our centre, this technique's clinical limitations compared to single-operator long-colonoscopy ERCP remain unclear.

METHODS

This retrospective study enrolled patients with complex surgically altered anatomy who underwent ERCP from 2021 to 2024, divided into the single-balloon enteroscopy-assisted ERCP (SBEAE) and long colonoscopy-assisted ERCP (LCAE) groups. The target site (i.e. native papilla or surgical anastomosis) was reached using a 'push and pull' method. In cases of failed biliopancreatic duct cannulation in the LCAE group, a plastic guide tube was inserted via the working channel with the distal end placed near the target site. The colonoscope was withdrawn, with the guide tube left in situ; a side-viewing duodenoscope was then advanced to reattempt cannulation. Biliary duct cannulation and overall procedure success rates were assessed.

RESULTS

Overall, 101 patients [SBEAE: 43 (42.6%) and LACE: 58 (57.4%)] were included (mean age: 60.95 ± 12.9 years; male, n = 61), with Roux-en-Y anastomosis (n = 67; 66.3%), Billroth-II gastrectomy with Braun anastomosis (n = 18; 17.8%), and pancreaticoduodenectomy (n = 16; 15.9%). Indications for ERCP included biliary tract (83.2%) and pancreatic (16.8%) diseases. Intubation by SBE and colonoscopy was successful in 34 (79.1%)/55 (94.8%) in the SBEAE/LCAE groups, respectively (p = 0.077), with mean procedure times of 70.5 ± 19.7 and 57.6 ± 23.4 min (p < 0.001). Overall procedural success, defined as successful cannulation and completion of the intended intervention, was achieved in 26 (60.5%) and 52 (89.7%) patients, respectively (p < 0.001). Intubation and cannulation rates via subsequent duodenoscopy were 90% and 94.4%, respectively, (mean procedure time: 83.5 ± 21.1 min) after failed cannulation (n = 20) in the LCAE group.

CONCLUSIONS

Our technique is effective and safe for patients with a complex surgically altered anatomy when performed by experienced endoscopists, showing superior endoscopic intubation and biliopancreatic duct cannulation compared to SBEAE.