Case Report
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World J Gastroenterol. Jul 28, 2012; 18(28): 3765-3769
Published online Jul 28, 2012. doi: 10.3748/wjg.v18.i28.3765
Direct cholangioscopy combined with double-balloon enteroscope-assisted endoscopic retrograde cholangiopancreatography
Tatsuya Koshitani, Shogo Matsuda, Koji Takai, Takayuki Motoyoshi, Makoto Nishikata, Yasuhide Yamashita, Toshihiko Kirishima, Naomi Yoshinami, Hiroyuki Shintani, Toshikazu Yoshikawa
Tatsuya Koshitani, Shogo Matsuda, Koji Takai, Takayuki Motoyoshi, Makoto Nishikata, Yasuhide Yamashita, Toshihiko Kirishima, Naomi Yoshinami, Hiroyuki Shintani, Department of Gastroenterology, Kyoto City Hospital, Kyoto 6048845, Japan
Toshikazu Yoshikawa, Department of Molecular Gastroenterology and Hepatology, Kyoto Prefectural University of Medicine Graduate School of Medical Science, Kyoto 6028566, Japan
Author contributions: Koshitani T and Matsuda S performed the research; Takai K, Motoyoshi T, Nishikata M, Yamashita Y, Kirishima T and Yoshinami N assisted with the research; Shintani H and Yoshikawa T supervised the research; Koshitani T and Matsuda S analyzed the data; Koshitani T wrote the paper.
Correspondence to: Tatsuya Koshitani, MD, Department of Gastroenterology, Kyoto City Hospital, 1-2 Mibu Higashitakada-cho, Nakagyo-ku, Kyoto 6048845, Japan. tkoshitani@aol.com
Telephone: +81-75-3115311 Fax: +81-75-3216025
Received: August 8, 2011
Revised: November 21, 2011
Accepted: April 22, 2012
Published online: July 28, 2012
Abstract

Double-balloon enteroscope (DBE)-assisted endoscopic retrograde cholangiopancreatography (ERCP) is an effective endoscopic approach for pancreatobiliary disorders in patients with altered gastrointestinal anatomy. Endoscopic interventions via DBE in these postoperative settings remain difficult because of the lack of an elevator and the use of extra-long ERCP accessories. Here, we report the usefulness of direct cholangioscopy with an ultra-slim gastroscope during DBE-assisted ERCP. Three patients with choledocholithiasis in postoperative settings (two patients after Billroth II gastrojejunostomy and one patient after Roux-en-Y gastrojejunostomy) were treated. DBE was used to gain access to the papilla under carbon dioxide insufflation, and endoscopic sphincterotomy was performed with a conventional sphincterotome. For direct cholangioscopy, the enteroscope was exchanged for an ultra-slim gastroscope through an incision in the overtube, which was inserted directly into the bile duct. Direct cholangioscopy was used to extract retained bile duct stones in two cases and to confirm the complete clearance of stones in one case. Bile duct stones were eliminated with a 5-Fr basket catheter under direct visual control. No adverse events were noted in any of the three cases. Direct cholangioscopy with an ultra-slim gastroscope facilitates subsequent treatment within the bile duct. This procedure represents another potential option during DBE-assisted ERCP.

Keywords: Direct cholangioscopy; Double-balloon enteroscope; Endoscopic retrograde cholangiopancreatography