Nennstiel S, Fried R, Herner A, Schlag C. Motorized spiral enteroscopy assisted endoscopic retrograde cholangiography in patients with Roux-en-Y-anatomy. World J Gastrointest Endosc 2025; 17(8): 102787 [DOI: 10.4253/wjge.v17.i8.102787]
Corresponding Author of This Article
Christoph Schlag, Chief Physician, Department of Gastroenterology and Hepatology, University of Zurich, Raemistrasse 100, Zurich 8091, Switzerland. christoph.schlag@usz.ch
Research Domain of This Article
Gastroenterology & Hepatology
Article-Type of This Article
Retrospective Cohort Study
Open-Access Policy of This Article
This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
World J Gastrointest Endosc. Aug 16, 2025; 17(8): 102787 Published online Aug 16, 2025. doi: 10.4253/wjge.v17.i8.102787
Motorized spiral enteroscopy assisted endoscopic retrograde cholangiography in patients with Roux-en-Y-anatomy
Simon Nennstiel, Ron Fried, Alexander Herner, Christoph Schlag
Simon Nennstiel, Ron Fried, Alexander Herner, Department of Gastroenterology and Hepatology, University Hospital Zurich, Zurich 8091, Switzerland
Christoph Schlag, Department of Gastroenterology and Hepatology, University of Zurich, Zurich 8091, Switzerland
Author contributions: Nennstiel S performed motorized spiral enteroscopy-procedures, collected data, and wrote the manuscript; Fried R collected data and wrote the manuscript; Herner A collected data and reviewed the manuscript; Schlag C performed motorized spiral enteroscopy-procedures and reviewed the manuscript; all of the authors read and approved the final version of the manuscript to be published.
Institutional review board statement: This retrospective analysis was approved by the local Institutional Review Board (Kantonale Ethikkomission Zurich, No. 2023-00115).
Informed consent statement: Informed consent for usage of the retrospective data was obtained with standardized general consent forms for clinical research in the local hospital.
Conflict-of-interest statement: Simon Nennstiel, Alexander Herner and Christoph Schlag report honoraria by Olympus Europe for educational events; Schlag Christoph furthermore received speaker’s honoraria from Boston Scientfic, Medtronic and Lumendi as well as consulting fees from Olympus, Boston Scientific and Medtronic; Ron Fried has no conflicts of interest or financial ties to disclose.
STROBE statement: The authors have read the STROBE Statement—checklist of items, and the manuscript was prepared and revised according to the STROBE Statement—checklist of items.
Data sharing statement: The datasets generated during and/or analyzed during the current study are not publicly available due to ethical reasons but are available from the corresponding author on reasonable request and with permission of the local Institutional Review Board.
Open Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Christoph Schlag, Chief Physician, Department of Gastroenterology and Hepatology, University of Zurich, Raemistrasse 100, Zurich 8091, Switzerland. christoph.schlag@usz.ch
Received: November 6, 2024 Revised: March 20, 2025 Accepted: July 29, 2025 Published online: August 16, 2025 Processing time: 287 Days and 12.3 Hours
Abstract
BACKGROUND
In postsurgical upper gastrointestinal anatomy, motorized spiral enteroscopy (MSE) assisted endoscopic retrograde cholangiopancreaticography (ERCP) was shown feasible and has the advantage that standard ERCP instruments can be used. Therefore, MSE-ERCP appears to be the optimal solution for postsurgical patients, especially with Roux-en-Y anatomy.
AIM
To show feasibility and safety of MSE-ERCP in patients with Roux-en-Y anatomy.
METHODS
We retrospectively analyzed all consecutive MSE-ERCP procedures in patients with Roux-en-Y anatomy between September 2021 and May 2023 in an endoscopic tertiary referral center.
RESULTS
We identified 26 MSE-ERCPs: (1) 18 MSE-ERCPs in 13 patients with Roux-en-Y anatomy after liver transplantation (n = 11) or gastrectomy (n = 2); and (2) Another 8 MSE-ERCP interventions in 5 patients with very long Roux-en-Y situation after gastric bypass. Overall success of reaching the biliary entry was 88% and further interventions were successful in 83% of patients. In very long alimentary limb situations, success of reaching the biliary entry was not-significantly lower compared to “standard” Roux-en-Y (75% vs 94%, P = 0.215). ERCP-interventions were not-significantly less successful in patients with native papilla compared to hepaticojejunostomy (63% vs 93%, P = 0.103). Mean intervention time was 105 minutes. Intervention times were longer in very long limb situations (133 minutes vs 91 minutes; P = 0.032). Overall, we observed three adverse events (n = 1 caused by enteroscopy, n = 1 caused by the biliary intervention, n = 1 unrelated to the procedure). In 15/26 cases (58%) MSE-ERCP was carried out on an outpatient basis.
CONCLUSION
MSE-ERCP has been a promising technique for patients with Roux-en-Y reconstruction requiring biliary interventions. However, MSE was recently withdrawn from the market due to severe safety concerns, which were not observed in this study.
Core Tip: Motorized spiral enteroscopy assisted endoscopic retrograde cholangiopancreaticography is a promising technique for performing biliary interventions in postsurgical patients with Roux-en-Y anatomy, achieving an 88% success rate for accessing the biliary entry and demonstrating feasibility in outpatient settings. Despite recent safety concerns leading to its market withdrawal, this study found no severe adverse events associated with the procedure.
