首页|Endoscopic treatment of biliopancreatic pathology in patients with Whipple's pancreaticoduodenectomy surgical variants:Lessons learned from single-balloon enteroscopy-assisted ERCP
Endoscopic treatment of biliopancreatic pathology in patients with Whipple's pancreaticoduodenectomy surgical variants:Lessons learned from single-balloon enteroscopy-assisted ERCP
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Background:Endoscopic treatment of biliopancreatic pathology is challenging due to surgically altered anatomy after Whipple's pancreaticoduodenectomy.This study aimed to evaluate the feasibility and safety of single-balloon enteroscopy-assisted endoscopic retrograde cholangiopancreatography(SBE-ERCP)to treat biliopancreatic pathology in patients with Whipple's pancreaticoduodenectomy surgical variants.Methods:We retrospectively analyzed 106 SBE-ERCP procedures in 46 patients with Whipple's variants.Technical and clinical success rates and adverse events were evaluated.Results:Biliary SBE-ERCP was performed in 34 patients and pancreatic SBE-ERCP in 17,including 5 with both indications.From a total of 106 SBE-ERCP procedures,76 were biliary indication with technical suc-cess rate of 68/76(90％)procedures and clinical success rate of 30/34(88％)patients.Mild adverse event rate was 8/76(11％),without serious adverse events.From a total of 106 SBE-ERCP procedures,30 were pancreatic indication with technical success rate of 24/30(80％)procedures(P=0.194 vs.biliary SBE-ERCP)and clinical success rate of 11/17(65％)patients(P=0.016 vs.biliary SBE-ERCP).Mild adverse event rate was 6/30(20％)(P=0.194 vs.biliary SBE-ERCP),without serious adverse events.After SBE-ERCP fail-ure,endoscopic ultrasound-guided drainage,percutaneous drainage and redo surgery were alternative therapeutic options.Conclusions:Biliopancreatic pathology after Whipple's pancreaticoduodenectomy variants can be treated using SBE-ERCP without serious adverse events.Technical and clinical success rates are high for biliary indications,whereas clinical success rate of pancreatic indications is significantly lower.SBE-ERCP can be considered as first-line treatment option in this patient group with surgically altered anatomy.
Rodrigo Garcés-Durán、Laurent Monino、Pierre H Deprez、Hubert Piessevaux、Tom G Moreels
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Department of Gastroenterology and Hepatology,Université catholique de Louvain,Cliniques Universitaires Saint-Luc,Avenue Hippocrates 10,1200 Brussels,Belgium
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