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

Table 1 Patients’ characteristics

	Liver operation group			Control group
	26 patients, 45 procedures			40 patients, 59 procedures
	Hepatectomy	LDLT	Total	PD	PPPD	SSPPD	Total
Sex, male: female, patients	7:7	4:8	11:15	8:1	3:1	15:12	26:14
(male: female, procedures)	(9:9)	(8:19)	(17:28)	(12:1)	(3:1)	(27:15)	(42:17)
Age, median, years old	70	27	61	66	67.5	66.5	67
(IQR)	(66.3-75.8)	(24.5-54.5)	(26-69)	(53-70)	(66.8-68)	(60.5-75)	(61-74)
Indication of surgical gastrointestinal reconstruction, procedures
Biliary disease (malignant)	14	0	14	2	0	8	10
Biliary disease (benign)	3	15	18	0	0	0	0
Liver disease (malignant)	1	3	4	0	0	0	0
Liver disease (benign)	0	9	9	0	0	0	0
Pancreatic disease (malignant)	0	0	0	8	4	27	39
Pancreatic disease (benign)	0	0	0	0	0	1	1
Gastric/duodenal disease (malignant)	0	0	0	3	0	6	9
Indication of DB-ERC (including duplication), procedures
Stenosis of hepaticojejunostomy	13	21	34	4	4	26	34
Bile duct stones	6	6	12	10	1	23	34
Cholangitis	4	5	9	3	1	9	13
Stenosis of biliary duct	1	4	5	0	0	2	2
Others	1	0	1	0	0	4	4

LDLT: Living donor liver transplantation; PD: Pancreatoduodenectomy; PPPD: Pylorus-preserving pancreatoduodenectomy; SSPPD: Subtotal stomach-preserving pancreatoduodenectomy; DB-ERC: Double-balloon endoscopic retrograde cholangiopancreatography; IQR: Interquartile range.

Table 2 Technical, diagnostic, therapeutic and overall success rates

	Liver operation group			Control group
	26 patients, 45 procedures			40 patients, 59 procedures
	Hepatec-tomy	LDLT	Total	PD	PPPD	SSPPD	Total	P value1	Effect size2
Technical success	16/18	26/27	42/45	13/13	4/4	40/42	57/59	0.439	0.076
Procedures (%)	(88.9)	(96.3)	(93.3)	(100)	(100)	(95.2)	(96.6)
Diagnostic success	11/16	24/26	35/42	12/12	3/4	31/39	46/55	0.968	0.004
Procedures (%)	(68.8)	(92.3)	(83.3)	(100)	(75.0)	(79.5)	(83.6)
Therapeutic success	10/10	22/23	32/33	12/12	3/3	28/29	43/44	0.836	0.024
Procedures (%)	(100)	(95.7)	(97.0)	(100)	(100)	(96.6)	(97.7)
Overall success	11/18	23/27	34/45	13/13	3/4	31/42	47/59	0.617	0.049
Procedures (%)	(61.1)	(85.2)	(75.6)	(100)	(75.0)	(73.8)	(79.7)

¹χ² (Total of Liver operation group vs Control group).

²phi coefficient. LDLT: Living donor liver transplantation; PD: Pancreatoduodenectomy; PPPD: Pylorus-preserving pancreatoduodenectomy; SSPPD: Subtotal stomach-preserving pancreatoduodenectomy; Technical success: Endoscope reached the hepaticojejunostomy site; Diagnostic success: Successful cholangiography after cannulation to the bile duct; Therapeutic success: Completed interventions in the bile duct; Overall success: Completed diagnosis and interventions among all procedures.

Table 3 Insertion and procedure time

	Liver operation group			Control group
	Hepatectomy	LDLT	Total	PD	PPPD	SSPPD	Total	P value1	Effect size2
Insertion time	19.5	24	22	14	26	14	14	< 0.001	0.772
Median, min (IQR)	(14.3-29.3)	(18-41)	(16-40)	(7-20)	(15.5-44.8)	(10.3-21.3)	(10-23)
Procedure time	45.5	40	43.5	34	18	30	30	0.033	0.444
Median, min (IQR)	(29.8-62.5)	(22.8-60.5)	(28.3-61.5)	(24-45)	(14.5-30.8)	(21.5-43.8)	(21-44)

¹Mann-Whitney U test (Total of Liver operation group vs Control group).

²Cohen’s d. LDLT: Living donor liver transplantation; PD: Pancreatoduodenectomy; PPPD: Pylorus-preserving pancreatoduodenectomy; SSPPD: Subtotal stomach-preserving pancreatoduodenectomy; Insertion time: The time required to reach the hepaticojejunostomy site; Procedure time: The time from reaching the hepaticojejunostomy site to removal of the endoscope; IQR: Interquartile range.

Table 4 Adverse events

	Liver operation group			Control group				P value1	Effect size2
	26 patients, 45 procedures			40 patients, 59 procedures
	Hepatectomy	LDLT	Total	PD	PPPD	SSPPD	Total
Adverse events	3/18	2/27	5/45	2/13	1/4	1/42	4/59	0.670	0.076
Procedures (%)	(16.7)	(7.4)	(11.1)	(15.4)	(25)	(2.4)	(6.8)
Cholangitis	2	0	2	2	0	1	3
Pancreatitis	1	0	1	0	1	0	1
Bleeding	0	2	2	0	0	0	0
Perforation	0	0	0	0	0	0	0

¹χ² (Total of Liver operation group vs Control group).

²phi coefficient. LDLT: Living donor liver transplantation; PD: Pancreatoduodenectomy; PPPD: Pylorus-preserving pancreatoduodenectomy. SSPPD: Subtotal stomach-preserving pancreatoduodenectomy.

Table 5 Differences of success rates, insertion and procedure time with or without adverse events

	With adverse events	Without adverse events
	9 patients, 9 procedures	57 patients, 95 procedures	P value1	Effect size2
Technical success	9/9	90/95	0.481	0.069
Procedures (%)	(100)	(94.7)
Diagnostic success	8/9	73/88	0.648	0.046
Procedures (%)	(88.9)	(83.0)
Therapeutic success	8/8	67/69	0.626	0.056
Procedures (%)	(100)	(97.1)
Overall success	8/9	73/95	0.405	0.082
Procedures (%)	(88.9)	(76.8)
Insertion time	16	18	0.795	0.093
Median, min (IQR)	(9-25)	(12-28)
Procedure time	60	34	0.034	0.762
Median, min (IQR)	(46-62)	(21-49)

¹χ²: success rates; Mann-Whitney U test: Insertion and procedure time.

²phi coefficient: success rates; Cohen’s d: Insertion and procedure time. Technical success: Endoscope reached the hepaticojejunostomy site; Diagnostic success: Successful cholangiography after cannulation to the bile duct; Therapeutic success: Completed interventions in the bile duct; Overall success: Completed diagnosis and interventions among all procedures; Insertion time: The time required to reach the hepaticojejunostomy site; Procedure time: The time from reaching the hepaticojejunostomy site to removal of the endoscope; IQR: Interquartile range.