Shing-Kao Yueh

Double-balloon enteroscopy application in biliary tract disease—its therapeutic and diagnostic functions

BACKGROUND On occasion, it is impossible to perform ERCP with a traditional duodenoscope in patients who have had a Billroth II gastrectomy or hepatojejunostomy, and who now have biliary tract problems. Repeat surgery is not a suitable course of action in these patients. Therefore, finding alternative modalities to resolve these obstructions is of great importance. OBJECTIVE To report successful endoscopic examination and treatment of difficult biliary obstructions by using double-balloon enteroscopy. PATIENTS Five patients. DESIGN Cases series. INTERVENTION Double-balloon enteroscopy (DBE) for biliary tract examination and treatment. RESULTS We report on 5 patients who underwent Billroth II gastrectomy or biliary tract Roux-en-Y surgery and who later had biliary tract obstruction from various causes. We were unable to perform ERCP with traditional duodenoscopy but successfully completed ERCP with DBE. DBE was originally designed to examine the small intestine. The successful biliary tract cannulation rate when using DBE is lower than with duodenoscope. We performed ERCP by using DBE a total of 5 times, with a successful biliary cannulation rate of 60%. We performed a special-method papillotomy in 2 patients. This method entailed inserting an electric sphincterotome through the percutaneous transhepatic cholangiography and drainage (PTCD) route after performing DBE intubation to the ampulla of Vater. We then successfully completed a papillotomy with an electric sphincterotome under DBE guidance. CONCLUSIONS DBE appears to be a promising alternative in the examination and treatment of biliary tract disease in patients after GI operations such as Billroth II gastrectomy and choledochojejunostomy.

Endoscopic Retrograde Cholangiopancreatography by Double Balloon Enteroscopy in Gastrectomized Patient: Report of a Case

Endoscopic retrograde cholangiopancreatography (ERCP) is a procedure for evaluation of the anatomy of pancreas and biliary tract and for internal drainage tube insertion. The success rate is nearly 100% with normal structure of duodenum and ampulla of Vater. However it is difficult in patient post subtotal gastrectomy with Billroth Ⅱ anastomosis and the success rate is only about 70-80%. Now we describe a patient with a history subtotal gastrectomy with Billroth II anastomosis, who presented with hepatic cystadenocarcinoma related obstructive jaundice and cholangitis. He underwent ERCP examination failure with lateral viewing duodenoscope but successful with double balloon enteroscope.