Skip to main content
Key Specialties
Cardiology Diabetology Endocrinology Gastroenterology Geriatrics and Gerontology Gynecology and Obstetrics Hematology Infectious Disease Internal Medicine Nephrology Neurology Oncology Pediatrics Respiratory Medicine Rheumatology Surgery
Congress Coverage
2024 ACC Congress 2023 ESMO Congress 2023 EASD Congress 2023 ERS Congress 2023 ESC Congress
Clinical Collections
Advances in Alzheimer’s

At a glance: The STEP trials

A round-up of the STEP phase 3 clinical trials evaluating semaglutide for weight loss in people with overweight or obesity.
ADVANCED SEARCH
Log in
Top
Surgical Endoscopy
Published in: Surgical Endoscopy 8/2011

01-08-2011

Modern enteroscopic interventions and characterization of nonmalignant postsurgical biliary anastomosis by double-balloon endoscopy

Authors: M. Raithel, A. Naegel, H. Dormann, Th. deRossi, H. Diebel, S. Raithel, F. Krauss, E. G. Hahn, J. Maiss

Published in: Surgical Endoscopy | Issue 8/2011

Login to get access

Abstract

Background

Endoscopic access to strictured biliodigestive anastomoses often is difficult and may require percutaneous transhepatic biliary drainage or reoperation.

Methods

Push- or push-and-pull enteroscopy was used to diagnose disease and treat 24 postsurgical patients with suspected strictured biliodigestive anastomosis. Endoscopic retrograde cholangiography and biliary interventional procedures were used. Endoscopic accessibility, diagnosis of disease, therapeutic success, and complication rates were investigated at a single tertiary university gastroeneterology center.

Results

Push enteroscopy reached biliary enteroanastomoses in 5 of the 24 patients (20.8%), whereas push-and-pull enteroscopy found choledocho- or hepaticojejunostomies in 17 of the remaining 19 postsurgical patients (89.4%). In all, successful enteroscopic intervention was achieved for 21 of the 24 patients (87.5%), whereas only 3 patients had to undergo percutaneous cholangiodrainage (12.5%). Cicatricially changed biliodigestive anastomoses were found in 14 of 21 patients (66.6%) including a mucosal type stricture in 7 patients (50%), an intramural type stricture in 5 patients (35.7%), and a ductal type stricture in 2 patients (14.2%). The remaining seven patients (33.3%) were normal. Enteroscopic interventions at strictured biliodigestive anastomosis included ostium incision for 8 (57.1%) and endoprosthesis insertion for 13 (92.8%) of the 14 patients, with prompt resolution of cholestasis and cholangitis. The major complications for the 24 patients involving 68 double-balloon enteroscopy (DBE) examinations comprised 2 perforations (8.3% per patient), 1 mild peritonitis (4.1%), and 1 cholangitis (4.1%), whereas minor complications were experienced by up to 20.8% of the patients.

Conclusions

Modern interventional enteroscopy yields a high rate of successful interventions for strictured biliodigestive anastomosis, requires ostium incision for mucosal and intramural types of strictures, and helps to reduce percutaneous approaches.
Literature
1.
Feitoza AB, Baron TH (2002) Endoscopy and ERCP in the setting of previous upper GI tract surgery: part II. Postsurgical anatomy with alteration of the pancreaticobiliary tree. Gastrointest Endosc 55:75–79PubMedCrossRef
2.
Park JS, Kim MH, Lee SK, Seo DW, Lee SS, Han J, Min YI, Hwang Sh, Park KM, Lee YJ, Lee SG, Sung KB (2003) Efficacy of endoscopic and percutaneous treatments for biliary complications after cadaveric and living donor liver transplantation. Gastrointest Endosc 57:78–85PubMedCrossRef
3.
Schumacher B, Othman T, Jansen M, Preiss C, Neuhaus H (2001) Long-term follow-up of percutaneous transhepatic therapy (PTT) in patients with definite benign anastomotic strictures after hepaticojejunostomy. Endoscopy 33:409–415PubMedCrossRef
4.
Ell C (2003) Perkutane transhepatische Cholangiographie (PTC-PTCD). In: Ell C, Brambs HJ, Fischbach W, Fleig WE, Gebel MJ, Groß V, Layer P, Stolte M, Zirngibl H (eds) Gastro update 470. Schnetztor-Verlag GmbH, Konstanz
5.
Yee AC, Ho CS (1990) Percutaneous transhepatic biliary drainage: a review. Crit Rev Diagn Imaging 30:247–249PubMed
6.
Yamamoto H, Sekine Y, Sato Y, Higashizawa T, Miyata T, Lino S, Ido K, Sugano K (2001) Total enteroscopy with a nonsurgical steerable double-balloon method. Gastrointest Endosc 53:216–220PubMedCrossRef
7.
Maiss J, Diebel H, Naegel A, Mueller B, Hochberger J, Hahn EG, Raithel M (2007) A novel model for training in ERCP with double-balloon entertoscopy after abdominal surgery. Endoscopy 39:1072–1075PubMedCrossRef
8.
Sato H, Yamamoto H, Tamada K, Kita H, Wada Sh, Sunada K, Tano Sh, Hayashi Y, Sato Y, Yano T, Hanatsuka K, Ajibe H, Hachimori H, Takamatsu T, Ito K, Shinozaki S, Iwamoto M, Miyata T, Kuno A, Tomiyama T, Ido K, Sugano K (2005) Application of double-balloon endoscopy for afferent limb lesions of Roux-en-Y surgical anstomoses. Gastrointest Endosc 61:AB238CrossRef
9.
Haber GB (2007) Double-balloon endoscopy for pancreatic and biliary access in altered anatomy (with videos). Gastrointest Endosc 66:S47–S50PubMedCrossRef
10.
Chu YC, ShJ Su, Yang CC, Yeh YH, Chen CH, Yueh SK (2007) ERCP plus papillotomy by use of double-balloon enteroscopy after Bilroth II gastrectomy. Gastrointest Endosc 66:1234–1236PubMedCrossRef
11.
Mönkemüller K, Fry LC, Belluti M, Neumann H, Malfertheiner P (2009) Therapeutic ERCP with the double-balloon enteroscope in patients with Roux-en-Y anastomosis. Surg Endosc 23:1961–1967PubMedCrossRef
12.
May A, Nachbar L, Schneider M, Ch Ell (2006) Prospective comparison of push enteroscopy and push-and-pull enteroscopy in patients with suspected small bowel bleeding. Am J Gastroenterol 101:2016–2024PubMedCrossRef
13.
Wright BE, Cass OW, Freemann ML (2002) ERCP in patients with long-limb Roux-en-Y gastrojejunostomy and intact papilla. Gastrointest Endosc 56:225–232PubMedCrossRef
14.
Hintze RE, Adler A, Veltzke W, Abou-Rebyeh H (1997) Endoscopic access to the papilla of Vater for endoscopic retrograde cholangiopancraticography in patients with Bilroth II or Roux-en-Y gastrojejunostomy. Endoscopy 29:69–73PubMedCrossRef
15.
May A, Nachbar L, Wardak A, Yamamoto H, Ell C (2003) Double-balloon enteroscopy: preliminary experience in patients with obscure gastrointestinal bleeding or chronic abdominal pain. Endoscopy 35:985–991PubMedCrossRef
16.
Kita H, Yamamoto H (2007) New indications of double-balloon endoscopy. Gastrointest Endosc 66:S57–S59PubMedCrossRef
17.
Haruta H, Yamamoto H, Mizuta K, Kita Y, Uno T, Egami S, Hishikawa S, Sugano K, Kawarasaki H (2005) A case of successful endocopic balloon dilation for late anastomotic stricture of choledochojejunostomy after living donor transplantation. Liver Transplant 11:1608–1610CrossRef
18.
Chahal P, Baron TH, Topazian MD, Pertesen BT, Levy MJ, Gostout CJ (2006) Endoscopic retrograde cholangiopancreaticography in post-Whipple patients. Endoscopy 38:1241–1245PubMedCrossRef
19.
Saleem A, Baron TH, Gostout CJ, Topazian MD, Levy MJ, Petersen BT, Wong Kee Song LM (2010) Endoscopic retrograde cholangiopacreaticography using a single-balloon enteroscope in patients with altered Roux-en-Y anatomy. Endoscopy 42:656–660PubMedCrossRef
20.
Chahal P, Baron TH, Poterucha JJ, Rosen CB (2007) Endoscopic retrograde cholangiography in postorthotopic liver transplant population with Roux-en-Y biliary reconstruction. Liver Transplant 13:1168–1173CrossRef
21.
Mönchemüller K, Bellutti M, Neumann H, Malfertheiner P (2008) Therapeutic ERCP with the double-balloon enteroscope in patients with Roux-en-Y anastomosis. Gastrointest Endosc 67:992–996CrossRef
22.
Neumann H, Fry LC, Meyer F, Malfertheiner P, Mönkemüller K (2009) Endoscopic retrograde cholangiopacreaticography using the single balloon enteroscope technique in patients with Roux-en-Y anastomosis. Digestion 80:52–57PubMedCrossRef
23.
Winick AB, Waybill PN, Venbrux AC (2001) Complications of percutaneous transhepatic biliary interventions. Tech Vasc Interv Radiol 4:200–206PubMedCrossRef
24.
Cohan RH, Illescas FF, Saeed M et al (1986) Infectious complications of percutaneous biliary drainage. Invest Radiol 21:705–709PubMedCrossRef
25.
Hamlin JA, Friedman M, Stein MG, Bay JF (1986) Percutaneous biliary drainage: complications of 118 consecutive catheterisations. Radiology 158:199–202PubMed
26.
Aabakken L, Bretthauer M, Line PD (2007) Double-balloon enteroscopy for endoscopic retrograde cholangiography in patients with a Roux-en-Y anastomosis. Endoscopy 39:1068–1071PubMedCrossRef
Metadata
Title
Modern enteroscopic interventions and characterization of nonmalignant postsurgical biliary anastomosis by double-balloon endoscopy
Authors
M. Raithel
A. Naegel
H. Dormann
Th. deRossi
H. Diebel
S. Raithel
F. Krauss
E. G. Hahn
J. Maiss
Publication date
01-08-2011
Publisher
Springer-Verlag
Published in
Surgical Endoscopy / Issue 8/2011
Print ISSN: 0930-2794
Electronic ISSN: 1432-2218
DOI
https://doi.org/10.1007/s00464-011-1581-9

Other articles of this Issue 8/2011

Surgical Endoscopy 8/2011 Go to the issue

OriginalPaper

Endoscopic mucosal resection using a cap-fitted panendoscope and endoscopic submucosal dissection as optimal endoscopic procedures for superficial esophageal carcinoma

OriginalPaper

Outpatient laparoscopic adrenalectomy: a new step ahead

Dynamic Manuscript

Multiple nerve blocks after video-assisted thoracic surgery (VATS)

OriginalPaper

A randomized prospective study of single-port and four-port approaches for hysterectomy in terms of postoperative pain

OriginalPaper

Seprafilm slurry does not increase complication rates after laparoscopic colectomy

Letter-Reply

Dangerous minimally invasive surgery: correct proposal