Balloon Enteroscopy-Assisted Endoscopic Retrograde Cholangiopancreatography for the Treatment of Common Bile Duct Stones in Patients with Roux-en-Y Gastrectomy: Outcomes and Factors Affecting Complete Stone Extraction

Taisuke Obata; Koichiro Tsutsumi; Hironari Kato; Toru Ueki; Kazuya Miyamoto; Tatsuhiro Yamazaki; Akihiro Matsumi; Yuki Fujii; Kazuyuki Matsumoto; Shigeru Horiguchi; Kengo Yasugi; Tsuneyoshi Ogawa; Ryuta Takenaka; Hiroyuki Okada

doi:10.3390/jcm10153314

Balloon Enteroscopy-Assisted Endoscopic Retrograde Cholangiopancreatography for the Treatment of Common Bile Duct Stones in Patients with Roux-en-Y Gastrectomy: Outcomes and Factors Affecting Complete Stone Extraction

J Clin Med. 2021 Jul 27;10(15):3314. doi: 10.3390/jcm10153314.

Affiliations

¹ Department of Gastroenterology, Okayama University Hospital, Okayama 7008558, Japan.
² Department of Internal Medicine, Fukuyama City Hospital, Fukuyama 7218511, Japan.
³ Department of Internal Medicine, Tsuyama Chuo Hospital, Okayama 7080841, Japan.

Abstract

Background: Endoscopic retrograde cholangiopancreatography (ERCP) for extraction of common bile duct (CBD) stones in patients with Roux-en-Y gastrectomy (RYG) remains technically challenging.

Methods: Seventy-nine RYG patients (median 79 years old) underwent short-type double-balloon enteroscopy-assisted ERCP (sDBE-ERCP) for CBD stones at three referral hospitals from 2011-2020. We retrospectively investigated the treatment outcomes and potential factors affecting complete stone extraction.

Results: The initial success rates of reaching the papilla of Vater, biliary cannulation, and biliary intervention, including complete stone extraction or biliary stent placement, were 92%, 81%, and 78%, respectively. Of 57 patients with attempted stone extraction, complete stone extraction was successful in 74% for the first session and ultimately in 88%. The adverse events rate was 5%. The multivariate analysis indicated that the largest CBD diameter ≥ 14 mm (odds ratio (OR), 0.04; 95% confidence interval (CI), 0.01-0.58; p = 0.018) and retroflex position (OR, 6.43; 95% CI, 1.12-36.81; p = 0.037) were independent predictive factors affecting complete stone extraction achievement.

Conclusions: Therapeutic sDBE-ERCP for CBD stones in a relatively elderly RYG cohort, was effective and safe. A larger CBD diameter negatively affected complete stone extraction, but using the retroflex position may be useful for achieving complete stone clearance.

Keywords: Roux-en-Y anastomosis; bile duct stone; complete stone removal; endoscopic retrograde cholangiography; gastrectomy; short-type balloon enteroscopy.