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Shimatani M, Mitsuyama T, Yamashina T, Takeo M, Horitani S, Saito N, Matsumoto H, Orino M, Kano M, Yuba T, Takayama T, Nakagawa T, Takayama S. Advanced technical tips and recent insights in ERCP using balloon-assisted endoscopy. DEN OPEN 2024; 4:e301. [PMID: 38023665 PMCID: PMC10644950 DOI: 10.1002/deo2.301] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 07/03/2023] [Revised: 09/26/2023] [Accepted: 09/30/2023] [Indexed: 12/01/2023]
Abstract
Pancreatobiliary endoscopic interventions using balloon-assisted endoscopes have been widely acknowledged as the first-line therapy for pancreatobiliary diseases in postoperative patients with reconstructed gastrointestinal anatomy (excluding the Billroth I procedure). However, there are many technical difficulties, and the procedural completion rates vary in a wide range among institutions, indicating the procedural technique is yet to be standardized. This article aims to provide technical tips of procedures and insights into the advanced aspects, including the management of extremely difficult cases and troubleshooting of endoscopic retrograde cholangiopancreatography using balloon endoscopy, along with a review of recent advancements in this field.
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Affiliation(s)
- Masaaki Shimatani
- Division of Gastroenterology and HepatologyKansai Medical University MedicalOsakaJapan
| | - Toshiyuki Mitsuyama
- Division of Gastroenterology and HepatologyKansai Medical University MedicalOsakaJapan
| | - Takeshi Yamashina
- Division of Gastroenterology and HepatologyKansai Medical University MedicalOsakaJapan
| | - Masahiro Takeo
- Division of Gastroenterology and HepatologyKansai Medical University MedicalOsakaJapan
| | - Shunsuke Horitani
- Division of Gastroenterology and HepatologyKansai Medical University MedicalOsakaJapan
| | - Natsuko Saito
- Division of Gastroenterology and HepatologyKansai Medical University MedicalOsakaJapan
| | - Hironao Matsumoto
- Division of Gastroenterology and HepatologyKansai Medical University MedicalOsakaJapan
| | - Masahiro Orino
- Division of Gastroenterology and HepatologyKansai Medical University MedicalOsakaJapan
| | - Masataka Kano
- Division of Gastroenterology and HepatologyKansai Medical University MedicalOsakaJapan
| | - Takafumi Yuba
- Division of Gastroenterology and HepatologyKansai Medical University MedicalOsakaJapan
| | - Takuya Takayama
- Division of Gastroenterology and HepatologyKansai Medical University MedicalOsakaJapan
| | - Tatsuya Nakagawa
- Division of Gastroenterology and HepatologyKansai Medical University MedicalOsakaJapan
| | - Shoji Takayama
- Division of Gastroenterology and HepatologyKansai Medical University MedicalOsakaJapan
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Kato S, Ono Y, Nakamura M, Fukino R, Nomura A, Matsumura M, Murai T, Itaya K, Koike Y, Izumi T, Endo A, Nishikawa S, Kuwatani M. Utility of a Passive Bending Colonoscope for Endoscopic Retrograde Cholangiopancreatography in Patients with Surgically Altered Anatomy. Dig Dis Sci 2024; 69:200-208. [PMID: 37930600 DOI: 10.1007/s10620-023-08163-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/19/2023] [Accepted: 10/17/2023] [Indexed: 11/07/2023]
Abstract
BACKGROUND AND AIM The utility of a passive bending colonoscope (PBCS) in ERCP for patients with surgically altered anatomy has not been established. This study compared the outcome of PBCS-ERCP and balloon-assisted enteroscope (BAE)-ERCP. METHODS This multicenter observational study included 343 patients with surgically altered anatomy who underwent ERCP. Among these, 110 underwent PBCS-ERCP and 233 underwent BAE-ERCP. Propensity score matching was applied, and a final cohort of 210 (105 in each group) with well-balanced backgrounds was analyzed. The primary outcome was the success rate of reaching anastomosis or ampulla of Vater. Secondary endpoints included the cannulation success rate, completion rate, procedure time (to reach, cannulate, complete), and adverse events. RESULTS The success rate for reaching the target was 91.4% (96/105) with PBCS and 90.5% (95/105) with BAE (odds ratio [95% CI] 1.12, [0.44-2.89], P = 0.809). The mean time required to reach the target was significantly shorter in PBCS: 10.04 min (SD, 9.62) with PBCS versus 18.77 min (SD, 13.21) with BAE (P < 0.001). There were no differences in the success of cannulation or procedure completion, although the required times for cannulation and procedure completion were significantly shorter in PBCS. The incidence of adverse events was significantly higher in BAE (19.0%) than in PBCS (4.8%; P < 0.001). CONCLUSIONS In patients with surgically altered anatomy, PBCS-ERCP showed promising results with shorter time to reach, cannulate, and a lower incidence of adverse events compared with BAE-ERCP. The success rate of reaching was favorable through PBCS compared with BAE. CLINICAL TRIAL REGISTRATION UMIN000045546.
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Affiliation(s)
- Shin Kato
- Department of Gastroenterology, Sapporo City General Hospital, Kita 11, Nishi 13, Chuo-Ku, Sapporo, Hokkaido, 060-8604, Japan.
| | - Yuji Ono
- Department of Gastroenterology, Sapporo City General Hospital, Kita 11, Nishi 13, Chuo-Ku, Sapporo, Hokkaido, 060-8604, Japan
| | - Michio Nakamura
- Department of Gastroenterology, Sapporo City General Hospital, Kita 11, Nishi 13, Chuo-Ku, Sapporo, Hokkaido, 060-8604, Japan
| | - Ryo Fukino
- Department of Gastroenterology, Sapporo City General Hospital, Kita 11, Nishi 13, Chuo-Ku, Sapporo, Hokkaido, 060-8604, Japan
| | - Asako Nomura
- Department of Gastroenterology, Sapporo City General Hospital, Kita 11, Nishi 13, Chuo-Ku, Sapporo, Hokkaido, 060-8604, Japan
| | - Mariko Matsumura
- Department of Gastroenterology, Sapporo City General Hospital, Kita 11, Nishi 13, Chuo-Ku, Sapporo, Hokkaido, 060-8604, Japan
| | - Taichi Murai
- Department of Gastroenterology, Sapporo City General Hospital, Kita 11, Nishi 13, Chuo-Ku, Sapporo, Hokkaido, 060-8604, Japan
| | - Kazufumi Itaya
- Department of Gastroenterology, Sapporo City General Hospital, Kita 11, Nishi 13, Chuo-Ku, Sapporo, Hokkaido, 060-8604, Japan
| | - Yuta Koike
- Department of Gastroenterology, Sapporo City General Hospital, Kita 11, Nishi 13, Chuo-Ku, Sapporo, Hokkaido, 060-8604, Japan
| | - Takaaki Izumi
- Department of Gastroenterology, Sapporo City General Hospital, Kita 11, Nishi 13, Chuo-Ku, Sapporo, Hokkaido, 060-8604, Japan
| | - Ayana Endo
- Department of Gastroenterology, Sapporo City General Hospital, Kita 11, Nishi 13, Chuo-Ku, Sapporo, Hokkaido, 060-8604, Japan
| | - Shuji Nishikawa
- Department of Gastroenterology, Sapporo City General Hospital, Kita 11, Nishi 13, Chuo-Ku, Sapporo, Hokkaido, 060-8604, Japan
| | - Masaki Kuwatani
- Department of Gastroenterology and Hepatology, Hokkaido University Hospital, Hokkaido, Japan
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Tanisaka Y, Mizuide M, Fujita A, Jinushi R, Ogawa T, Katsuda H, Saito Y, Miyaguchi K, Mashimo Y, Ryozawa S. Competence development of trainees performing short-type single-balloon enteroscopy-assisted endoscopic retrograde cholangiopancreatography in patients with surgically altered anatomy. JOURNAL OF HEPATO-BILIARY-PANCREATIC SCIENCES 2022; 29:1316-1326. [PMID: 35594030 DOI: 10.1002/jhbp.1187] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/10/2022] [Revised: 04/01/2022] [Accepted: 04/17/2022] [Indexed: 12/24/2022]
Abstract
OBJECTIVES This study aimed to evaluate the trainees' practice and learning curve in short-type single-balloon enteroscopy (short SBE)-assisted endoscopic retrograde cholangiopancreatography (ERCP) for patients with surgically altered anatomy (SAA) and determine how to train these trainees. METHODS The data of short SBE-assisted ERCP procedures between September 2011 and June 2021 were analyzed. RESULTS Three trainees and 180 cases were included in the analysis. Each trainee performed 60 cases between April 2016 and June 2021. The trainees' completion rate was 73.9% (95% confidence interval [CI], 66.8-80.1%). Adverse events occurred in 5.0% of cases (95% CI, 2.3-9.3%). The trainee who experienced colonoscopy and ERCP the most achieved better outcomes of enteroscopy success (reaching the target site) and trainee's completion rates than those of the others (P = .03 and .02, respectively). The learning curve for trainee's completion showed a significant improvement after 60 cases (P = .001). Multiple logistic regression analysis indicated that Roux-en-Y reconstruction was the factor affecting trainees' completion failure. CONCLUSIONS Short SBE-assisted ERCP trainees has a substantial learning curve. If trainees do not have much experience with colonoscopy and ERCP procedures, it may be beneficial for them to start performing short SBE-assisted ERCP procedures on non-Roux-en-Y reconstruction cases.
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Affiliation(s)
- Yuki Tanisaka
- Department of Gastroenterology, Saitama Medical University International Medical Center, Hidaka, Japan
| | - Masafumi Mizuide
- Department of Gastroenterology, Saitama Medical University International Medical Center, Hidaka, Japan
| | - Akashi Fujita
- Department of Gastroenterology, Saitama Medical University International Medical Center, Hidaka, Japan
| | - Ryuhei Jinushi
- Department of Gastroenterology, Saitama Medical University International Medical Center, Hidaka, Japan
| | - Tomoya Ogawa
- Department of Gastroenterology, Saitama Medical University International Medical Center, Hidaka, Japan
| | - Hiromune Katsuda
- Department of Gastroenterology, Saitama Medical University International Medical Center, Hidaka, Japan
| | - Yoichi Saito
- Department of Gastroenterology, Saitama Medical University International Medical Center, Hidaka, Japan
| | - Kazuya Miyaguchi
- Department of Gastroenterology, Saitama Medical University International Medical Center, Hidaka, Japan
| | - Yumi Mashimo
- Department of Gastroenterology, Saitama Medical University International Medical Center, Hidaka, Japan
| | - Shomei Ryozawa
- Department of Gastroenterology, Saitama Medical University International Medical Center, Hidaka, Japan
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Deliwala SS, Chawla S. Ballooning Your Way in Altered Anatomy ERCP: Ready for Deductive Learning. Dig Dis Sci 2022; 67:2696-2698. [PMID: 35001243 DOI: 10.1007/s10620-021-07348-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 11/23/2021] [Indexed: 12/09/2022]
Affiliation(s)
- Smit S Deliwala
- Department of Medicine, Michigan State University at Hurley Medical Center, Flint, MI, USA
| | - Saurabh Chawla
- Division of Digestive Diseases, Department of Medicine, Emory University School of Medicine, Atlanta, GA, 30322, USA.
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