Endoscopic retrograde cholangiopancreatography using short‐type double‐balloon enteroscope: Experience in Hong Kong

Objective To illustrate the efficacy and safety profile of double‐balloon enteroscopy (DBE)‐assisted endoscopic retrograde cholangiopancreatography (ERCP) using a short enteroscope in patients with surgically altered anatomy. Methods A retrospective study was performed to review the endoscopic outcomes of patients undergoing DBE‐assisted ERCP for biliary diseases in Tuen Mun and Pok Oi hospitals in Hong Kong SAR, China from December 2015 to December 2020. Results Altogether 46 DBE‐assisted ERCP procedures were performed in 37 patients. The enteroscopic success rate, defined as reaching the papilla or bilioenteric anastomosis, was 95.7% (95% confidence interval [CI] 85.2%‐99.5%), which was significantly lower in patients with intact stomach than in those who had a previous gastrectomy (67% vs 100%, P = 0.014). The diagnostic ERCP success rate, defined as performance in an informative cholangiogram, was 84.1% (95% CI 69.9%‐93.4%) in cases where it was attempted. Intended biliary therapeutic interventions were successfully performed in 76.1% (95% CI 61.2%‐87.4%) of all procedures. Adverse events were reported in six (13.0%) procedures (95% CI 4.9%‐26.3%), including the micro‐perforation of the intestine in two (4.3%) patients with prior Roux‐en‐Y gastrectomy, three (6.5%) of acute cholangitis and one (2.2%) of acute pancreatitis. All adverse events were managed successfully using conservative methods except in one case of micro‐perforation, which required a laparotomy. Conclusions DBE‐assisted ERCP using a short enteroscope is a promising technique for managing biliary diseases in patients with surgically altered anatomy. It must be performed to avoid perforation, particularly in patients with a Roux‐en‐Y reconstruction. Altogether 46 procedures of double‐balloon enteroscopy (DBE)‐assisted endoscopic retrograde cholangiopancreatograpy (ERCP) using a short enteroscope were performed in 37 patients with surgically altered anatomy. The enteroscopic success rate was 95.7% (44/46) while the diagnostic ERCP success rate was 84.1% (37/44) in attempted cases. Intended biliary therapeutic interventions were successfully performed in 76.1% (35/46) of all procedures.