Double-balloon endoscopic retrograde cholangiopancreatography for patients who underwent liver operation: A retrospective study

doi:10.3748/wjg.v26.i10.1056

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World Journal of Gastroenterology

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Retrospective Study

World J Gastroenterol. Mar 14, 2020; 26(10): 1056-1066
Published online Mar 14, 2020. doi: 10.3748/wjg.v26.i10.1056

Double-balloon endoscopic retrograde cholangiopancreatography for patients who underwent liver operation: A retrospective study

Ryo Nishio, Hiroki Kawashima, Masanao Nakamura, Eizaburo Ohno, Takuya Ishikawa, Takeshi Yamamura, Keiko Maeda, Tsunaki Sawada, Hiroyuki Tanaka, Daisuke Sakai, Ryoji Miyahara, Masatoshi Ishigami, Yoshiki Hirooka, Mitsuhiro Fujishiro

Ryo Nishio, Masanao Nakamura, Eizaburo Ohno, Takuya Ishikawa, Hiroyuki Tanaka, Daisuke Sakai, Ryoji Miyahara, Masatoshi Ishigami, Mitsuhiro Fujishiro, Department of Gastroenterology and Hepatology, Nagoya University Graduate School of Medicine, Aichi Prefecture, Nagoya 4668550, Japan

Hiroki Kawashima, Takeshi Yamamura, Keiko Maeda, Tsunaki Sawada, Department of Endoscopy, Nagoya University Hospital, Aichi Prefecture, Nagoya 4668550, Japan

Yoshiki Hirooka, Department of Liver, Biliary Tract and Pancreas Diseases, Fujita Health University Hospital, Aichi Prefecture, Toyoake 4701192, Japan

Author contributions: Nishio R contributed to the conception and design; Nishio R, Kawashima H and Ishikawa T contributed to the analysis and interpretation of the data; Nishio R drafted the article; Kawashima H, Nakamura M, Ohno E, Ishikawa T, Yamamura T, Maeda K, Sawada T, Tanaka H, Sakai D, Miyahara R, Masatoshi Ishigami M and Hirooka Y contributed to critical revision of the article for important intellectual content; Fujishiro M made final approval of the article.

Institutional review board statement: The study was reviewed and approved by the Ethics Committee of Nagoya University Hospital.

Informed consent statement: All study participants provided informed written consent prior to study enrollment.

Conflict-of-interest statement: Department of Gastroenterology and Hepatology, Nagoya University Graduate School of Medicine is receiving a scholarship donation from FUJIFILM. There are no additional conflict of interest that would pertain to the content of this study.

Data sharing statement: No additional data are available.

Corresponding author: Hiroki Kawashima, MD, PhD, Associate Professor, Department of Endoscopy, Nagoya University Hospital, 65 Tsurumai-cho, Showa-ku, Aichi Prefecture, Nagoya 4668550, Japan. h-kawa@med.nagoya-u.ac.jp

Received: November 26, 2019
Peer-review started: November 26, 2019
First decision: January 7, 2020
Revised: January 14, 2020
Accepted: February 15, 2020
Article in press: February 15, 2020
Published online: March 14, 2020
Processing time: 109 Days and 8.3 Hours

Abstract

BACKGROUND

Double-balloon endoscopic retrograde cholangiography (DB-ERC) is widely performed for biliary diseases after reconstruction in gastrointestinal surgery, but there are few reports on DB-ERC after hepatectomy or living donor liver transplantation (LDLT).

AIM

To examine the success rates and safety of DB-ERC after hepatectomy or LDLT.

METHODS

The study was performed retrospectively in 26 patients (45 procedures) who underwent hepatectomy or LDLT (liver operation: LO group) and 40 control patients (59 procedures) who underwent pancreatoduodenectomy (control group). The technical success (endoscope reaching the choledochojejunostomy site), diagnostic success (performance of cholangiography), therapeutic success (completed interventions) and overall success rates, insertion and procedure (completion of DB-ERC) time, and adverse events were compared between these groups.

RESULTS

There were no significant differences between LO and control groups in the technical [93.3% (42/45) vs 96.6% (57/59), P = 0.439], diagnostic [83.3% (35/42) vs 83.6% (46/55), P = 0.968], therapeutic [97.0% (32/33) vs 97.7% (43/44), P = 0.836], and overall [75.6% (34/45) vs 79.7% (47/59), P = 0.617] success rates. The median insertion time (22 vs 14 min, P < 0.001) and procedure time (43.5 vs 30 min, P = 0.033) were significantly longer in the LO group. The incidence of adverse events showed no significant difference [11.1% (5/45) vs 6.8% (4/59), P = 0.670].

CONCLUSION

DB-ERC after liver operation is safe and useful but longer time is required, so should be performed with particular care.

Keywords: Biliary tract diseases; Double-balloon enteroscopy; Endoscopic retrograde cholangiopancreatography; Hepatectomy; Liver transplantation; Risk management

Core tip: The utility of double-balloon endoscopic retrograde cholangiography (DB-ERC) has been widely reported, but the success rates and the examination time varied by reconstruction methods. There are no reports about DB-ERC after hepatectomy, but if the liver was resected, DB-ERC will be more difficult. We compared the elements of DB-ERC after hepatectomy or living donor liver transplantation with control group (after pancreatoduodenectomy). The success rates and incidence of adverse events were equivalent, but the insertion and procedure time were significantly longer. We discuss the difficulty of DB-ERC after hepatectomy.