Learning Curve of Endoscopic Retrograde Cholangiopancreatography Using Single-Balloon Enteroscopy

Overview

Journal Dig Dis Sci

Specialty Gastroenterology

Date 2022 Jan 1

PMID 34973148

Citations 4

Authors

Kunihiro Hosono

Takamitsu Sato

Sho Hasegawa

Yusuke Kurita

Shin Yagi

Akito Iwasaki

Yuji Fujita

Yusuke Sekino

Emiko Tanida

Takaomi Kessoku

Shingo Kato

Takuma Higurashi

Masato Yoneda

Kensuke Kubota

Atsushi Nakajima

Affiliations

Soon will be listed here.

Abstract

Background: Endoscopic retrograde cholangiopancreatography (ERCP) in patients with surgically altered anatomy is technically difficult. Extensive training is required to develop the ability to perform this procedure.

Aims: To investigate the learning curve of single-balloon-assisted enteroscopy ERCP (SBE-ERCP).

Methods: We conducted a retrospective, observational case series at a single center. We evaluated the SBE-ERCP procedures between April 2011 and February 2021. The main outcomes were the rate of reaching the target site and the success rate of the entire procedure. These parameters were additionally expressed as a learning curve.

Results: A total of 687 SBE-ERCP procedures were analyzed. The learning curve was analyzed in blocks of 10 cases. In this study, seven endoscopists, experts in conventional ERCP, were included. The overall SBE-ERCP procedural success rate was 92.2% (634/687 cases). Combining all data from individual endoscopists' evaluation periods, the insertion and success rates of the SBE-ERCP procedures gradually increased with increased experience performing SBE-ERCP. The insertion success rates for the number of SBE-ERCP cases (< 20, 21-30, > 30) were 82.9%, 92.9%, and 94.3%, respectively; the procedure success rates were 74.3%, 81.4%, and 92.9%, respectively. The endoscopists who had performed > 30 SBE-ERCP cases had a success rate of ≥ 90%.

Conclusions: Our results suggest that performing > 30 cases is one of the targets for conventional ERCP experts to become competent in performing SBE-ERCP in patients with a surgically altered anatomy.

Citing Articles

Use of short single-balloon enteroscopy in patients with surgically altered anatomy: a single-center experience.

Ding S, Dong S, Zhu H, Hu Y, Zheng S, Li Q Sci Rep. 2024; 14(1):27889.

PMID: 39537967 PMC: 11560932. DOI: 10.1038/s41598-024-79633-3.

Endoscopic Management of Biliary and Pancreatic Pathologies in Roux-en-Y Gastric Bypass Patients: Development of a Treatment Algorithm Based on 9-Year Experience.

Monino L, Marique L, Deswysen Y, Thoma M, Deprez P, Goffette P Obes Surg. 2024; 34(10):3717-3725.

PMID: 39225915 DOI: 10.1007/s11695-024-07471-3.

Advanced technical tips and recent insights in ERCP using balloon-assisted endoscopy.

Shimatani M, Mitsuyama T, Yamashina T, Takeo M, Horitani S, Saito N DEN Open. 2023; 4(1):e301.

PMID: 38023665 PMC: 10644950. DOI: 10.1002/deo2.301.

Utility of a Passive Bending Colonoscope for Endoscopic Retrograde Cholangiopancreatography in Patients with Surgically Altered Anatomy.

Kato S, Ono Y, Nakamura M, Fukino R, Nomura A, Matsumura M Dig Dis Sci. 2023; 69(1):200-208.

PMID: 37930600 DOI: 10.1007/s10620-023-08163-1.

References

Chu Y, Su S, Yang C, Yeh Y, Chen C, Yueh S . ERCP plus papillotomy by use of double-balloon enteroscopy after Billroth II gastrectomy. Gastrointest Endosc. 2007; 66(6):1234-6. DOI: 10.1016/j.gie.2007.04.030. View

Ishii K, Itoi T, Tonozuka R, Itokawa F, Sofuni A, Tsuchiya T . Balloon enteroscopy-assisted ERCP in patients with Roux-en-Y gastrectomy and intact papillae (with videos). Gastrointest Endosc. 2015; 83(2):377-86.e6. DOI: 10.1016/j.gie.2015.06.020. View

Freeman M, Guda N . ERCP cannulation: a review of reported techniques. Gastrointest Endosc. 2005; 61(1):112-25. DOI: 10.1016/s0016-5107(04)02463-0. View

Trindade A, Mella J, Slattery E, Cohen J, Dickstein J, Garud S . Use of a cap in single-balloon enteroscopy-assisted endoscopic retrograde cholangiography. Endoscopy. 2014; 47(5):453-6. DOI: 10.1055/s-0034-1391077. View

Cotton P, Eisen G, Aabakken L, Baron T, Hutter M, Jacobson B . A lexicon for endoscopic adverse events: report of an ASGE workshop. Gastrointest Endosc. 2010; 71(3):446-54. DOI: 10.1016/j.gie.2009.10.027. View

Siddiqui A, Chaaya A, Shelton C, Marmion J, Kowalski T, Loren D . Utility of the short double-balloon enteroscope to perform pancreaticobiliary interventions in patients with surgically altered anatomy in a US multicenter study. Dig Dis Sci. 2012; 58(3):858-64. DOI: 10.1007/s10620-012-2385-z. View

Hintze R, Adler A, Veltzke W, Abou-Rebyeh H . Endoscopic access to the papilla of Vater for endoscopic retrograde cholangiopancreatography in patients with billroth II or Roux-en-Y gastrojejunostomy. Endoscopy. 1997; 29(2):69-73. DOI: 10.1055/s-2007-1004077. View

Liu K, Joshi V, Saxena P, Kaffes A . Predictors of success for double balloon-assisted endoscopic retrograde cholangiopancreatography in patients with Roux-en-Y anastomosis. Dig Endosc. 2016; 29(2):190-197. DOI: 10.1111/den.12739. View

Tokuhara M, Shimatani M, Mitsuyama T, Masuda M, Ito T, Miyamoto S . Evaluation of complications after endoscopic retrograde cholangiopancreatography using a short type double balloon endoscope in patients with altered gastrointestinal anatomy: a single-center retrospective study of 1,576 procedures. J Gastroenterol Hepatol. 2020; 35(8):1387-1396. DOI: 10.1111/jgh.15019. View

10.

Elton E, Hanson B, Qaseem T, Howell D . Diagnostic and therapeutic ERCP using an enteroscope and a pediatric colonoscope in long-limb surgical bypass patients. Gastrointest Endosc. 1998; 47(1):62-7. DOI: 10.1016/s0016-5107(98)70300-1. View

11.

Haruta H, Yamamoto H, Mizuta K, Kita Y, Uno T, Egami S . A case of successful enteroscopic balloon dilation for late anastomotic stricture of choledochojejunostomy after living donor liver transplantation. Liver Transpl. 2005; 11(12):1608-10. DOI: 10.1002/lt.20623. View

12.

Feitoza A, Baron T . Endoscopy and ERCP in the setting of previous upper GI tract surgery. Part II: postsurgical anatomy with alteration of the pancreaticobiliary tree. Gastrointest Endosc. 2002; 55(1):75-9. DOI: 10.1067/mge.2002.120385. View

13.

Faulx A, Lightdale J, Acosta R, Agrawal D, Bruining D, Chandrasekhara V . Guidelines for privileging, credentialing, and proctoring to perform GI endoscopy. Gastrointest Endosc. 2017; 85(2):273-281. DOI: 10.1016/j.gie.2016.10.036. View

14.

Azeem N, Tabibian J, Baron T, Orhurhu V, Rosen C, Petersen B . Use of a single-balloon enteroscope compared with variable-stiffness colonoscopes for endoscopic retrograde cholangiography in liver transplant patients with Roux-en-Y biliary anastomosis. Gastrointest Endosc. 2013; 77(4):568-77. DOI: 10.1016/j.gie.2012.11.031. View

15.

Ekkelenkamp V, Koch A, Rauws E, Borsboom G, de Man R, Kuipers E . Competence development in ERCP: the learning curve of novice trainees. Endoscopy. 2014; 46(11):949-55. DOI: 10.1055/s-0034-1377930. View

16.

Raithel M, Dormann H, Naegel A, Boxberger F, Hahn E, Neurath M . Double-balloon-enteroscopy-based endoscopic retrograde cholangiopancreatography in post-surgical patients. World J Gastroenterol. 2011; 17(18):2302-14. PMC: 3098398. DOI: 10.3748/wjg.v17.i18.2302. View

17.

Haber G . Double balloon endoscopy for pancreatic and biliary access in altered anatomy (with videos). Gastrointest Endosc. 2007; 66(3 Suppl):S47-50. DOI: 10.1016/j.gie.2007.06.017. View

18.

Yane K, Katanuma A, Maguchi H, Takahashi K, Kin T, Ikarashi S . Short-type single-balloon enteroscope-assisted ERCP in postsurgical altered anatomy: potential factors affecting procedural failure. Endoscopy. 2016; 49(1):69-74. DOI: 10.1055/s-0042-118301. View

19.

Takano S, Fukasawa M, Shindo H, Takahashi E, Hirose S, Fukasawa Y . Risk factors for perforation during endoscopic retrograde cholangiopancreatography in post-reconstruction intestinal tract. World J Clin Cases. 2019; 7(1):10-18. PMC: 6327124. DOI: 10.12998/wjcc.v7.i1.10. View

20.

Shimatani M, Hatanaka H, Kogure H, Tsutsumi K, Kawashima H, Hanada K . Diagnostic and Therapeutic Endoscopic Retrograde Cholangiography Using a Short-Type Double-Balloon Endoscope in Patients With Altered Gastrointestinal Anatomy: A Multicenter Prospective Study in Japan. Am J Gastroenterol. 2016; 111(12):1750-1758. DOI: 10.1038/ajg.2016.420. View