The feasibility of cap‐assisted routine adult colonoscope for therapeutic endoscopic retrograde cholangiopancreatography in patients with Roux‐en‐Y reconstruction after total gastrectomy

• Published in: Journal of digestive diseases 2021-12, Vol.22 (12), p.721-726
• Main Authors: Ni, Jian Bo, Zhu, Mei Ying, Li, Kai, Dai, Wei Ming, Lu, Lun Gen, Wan, Xin Jian, Wan, Rong, Cai, Xiao Bo
• Format: Article
• Language: English
• Subjects: Acute Disease; Adverse events; Cannulation; cap‐assisted; Cholangiopancreatography, Endoscopic Retrograde; Cholangitis; Colonoscopes; colonoscopy; endoscopic retrograde cholangiopancreatography; Endoscopy; Feasibility Studies; Gastrectomy; Gastrectomy - adverse effects; Gastrointestinal surgery; Humans; Pancreatitis; Patients; Roux‐en‐Y reconstruction
• ISSN: 1751-2972; 1751-2980
• DOI: 10.1111/1751-2980.13069

Objectives Endoscopic retrograde cholangiopancreatography (ERCP) in patients with Roux‐en‐Y reconstruction after total gastrectomy is difficult to be performed using routine tools. The aim of this study was to evaluate the feasibility and safety of cap‐assisted routine adult colonoscope (CARAC) for ERCP in these patients. Methods Sixteen consecutive patients with indications of ERCP who had previously undergone total gastrectomy with Roux‐en‐Y reconstruction at two tertiary care endoscopy centers were identified. All ERCP procedures were carried out by using CARAC. The success rate of reaching the papilla, biliary cannulation and procedure‐related adverse events were analyzed. Results The papilla was successful reached in 11 (68.8%) of the 16 cases, and biliary cannulation was subsequently reached in eight (72.7%) of the 11 cases. The procedures succeeded in three patients by using a percutaneous–endoscopic rendezvous procedure after failed cannulation. Overall clinical success was achieved in 11 (68.8%) of 16 patients. Procedure‐related mild acute pancreatitis was observed in 25.0% (4/16) of the cases and mild cholangitis in 18.8% (3/16). No serious adverse events were reported. Conclusions CARAC for therapeutic ERCP is safe and effective in treating patients with Roux‐en‐Y reconstruction after total gastrectomy. Cap‐assisted routine adult colonoscope (CARAC) is effective and safe for the performance of endoscopic retrograde cholangiopancreatography (ERCP) in patients with Roux‐en‐Y reconstruction after total gastrectomy. In patients with difficult biliary access and dilated intrahepatic bile ducts, percutaneous transhepatic cholangial drainage‐ERCP rendezvous could also be considered as an appropriate salvage technique.