ERCP using balloon-assisted endoscope versus EUS-guided treatment for common bile duct stones in Roux-en-Y gastrectomy

• Published in: Gastrointestinal endoscopy 2023-09
• Main Authors: Sato, Tatsuya, Nakai, Yousuke, Kogure, Hirofumi, Mitsuyama, Toshiyuki, Shimatani, Masaaki, Uemura, Shinya, Iwashita, Takuji, Tanisaka, Yuki, Ryozawa, Shomei, Tsuchiya, Takayoshi, Itoi, Takao, Kin, Toshifumi, Katanuma, Akio, Kashima, Ken, Irisawa, Atsushi, Kayashima, Atsuto, Iwasaki, Eisuke, Yoshida, Akihiro, Takenaka, Mamoru, Himei, Hitomi, Kato, Hironari, Masuda, Atsuhiro, Shiomi, Hideyuki, Kawakubo, Kazumichi, Kuwatani, Masaki, Otsuka, Takeshi, Matsubara, Saburo, Nishioka, Nobu, Ogura, Takeshi, Tamura, Takaaki, Kitano, Masayuki, Hayashi, Nobuhiko, Yasuda, Ichiro, Fujishiro, Mitsuhiro
• Format: Article
• Language: English
• ISSN: 1097-6779; 1097-6779
• DOI: 10.1016/j.gie.2023.09.001

To compare endoscopic retrograde cholangiopancreatography using balloon-assisted endoscope (BE-ERCP) with endoscopic ultrasonography-guided antegrade treatment (EUS-AG) for removal of common bile duct (CBD) stones in patients with Roux-en-Y (R-Y) gastrectomy.BACKGROUND AND AIMSTo compare endoscopic retrograde cholangiopancreatography using balloon-assisted endoscope (BE-ERCP) with endoscopic ultrasonography-guided antegrade treatment (EUS-AG) for removal of common bile duct (CBD) stones in patients with Roux-en-Y (R-Y) gastrectomy.Consecutive patients with R-Y gastrectomy undergoing BE-ERCP or EUS-AG for CBD stones in 16 centers were retrospectively analyzed.METHODSConsecutive patients with R-Y gastrectomy undergoing BE-ERCP or EUS-AG for CBD stones in 16 centers were retrospectively analyzed.BE-ERCP and EUS-AG were performed in 588 and 59 patients, respectively. Baseline characteristics were similar, except for CBD diameter and angle. Technical success rate was 83.7% vs. 83.1% (P = 0.956), complete stone removal rate was 78.1% vs. 67.8% (P = 0.102), and early adverse event rate was 10.2% vs. 18.6% (P = 0.076) in BE-ERCP and EUS-AG. The mean number of endoscopic sessions was smaller in BE-ERCP (1.5±0.8 vs. 1.9±1.0 sessions, P = 0.01), whereas the median total treatment time was longer (90 vs. 61.5 minutes, P = 0.001). Among patients with biliary access, complete stone removal rate was significantly higher in BE-ERCP (93.3% vs. 81.6%, P = 0.009). CBD diameter ≥15-mm (Odds ratio [OR], 0.41) and an angle of CBD